THE 

MODERN  TREATMENT 

OF  ALCOHOLISM 
AND  DRUG  NARCOTISM 


C.  A.  McBRIDE,  M.D.,  L.R.C.P.  &  S.(Edin.) 


NEW    YORK 
REBMAN     COMPANY 

1123    BROADWAY 


All  Rights  Reserved 


THE   MODERN   TREATMENT 

OF   ALCOHOLISM 

AND   DRUG   NARCOTISM 


PREFACE 

For  some  years  past  I  have  been  entreated 
by  colleagues  and  friends  to  write  the  impres- 
sions and  experiences  gained  during  my  thirty 
years'  treatment  of  alcoholic  and  drug  inebriates. 
From  a  literary  point  of  view,  I  knew  myself 
incapable  of  producing  a  satisfactory  work,  but 
when  it  was  pointed  out  to  me  that  there  was 
no  book  published  dealing  fully  with  the  special 
method  of  treatment  which  I  had  used  with  more 
than  ordinary  success  during  all  those  long  years, 
I  felt  I  ought  to  place  my  experiences  on  record, 
no  matter  how  imperfectly  it  might  be  done. 

Throughout  the  book  I  have  written  for  two 
classes  of  readers,  namely,  those  of  my  own  pro- 
fession who  may  be  interested  in  the  treatment  of 
inebriety,  and  those  of  the  laity  interested  in  the 
subject.  The  book  therefore  is  written  in  the 
simplest  style  possible,  the  only  exception  to 
this  being  the  chapters  on  pathology  and  treat- 

V 

6(55297 


vi  PREFACE 

ment.  It  is  impossible  to  transmit  to  paper  the 
skill  acquired  during  long  years  in  the  apphcation 
of  any  line  of  treatment,  but  short  of  this  I  have 
endeavoured  to  make  the  book  as  practical  as 
possible,  and  sincerely  trust  it  may  prove  to 
be  so. 

30  New  Cavendish  Street, 
Harley  Street,  W., 


CONTENTS 


I.  What  is  Inebriety 
II.  Pathology  . 

III.  The  Causes  of  Inebriety 

IV.  Forms  of  Inebriety 
V.  Treatment 

VI.  Ether  Inebriety,  Etc.  . 
Index 


PAGE 

I 

lO 

47 
104 
162 
299 
374 


MODERN    TREATMENT 
OF    ALCOHOLISM 

CHAPTER  I 
WHAT    IS    INEBRIETY? 

The  View  of  the  Ancients 

The  superiority  of  the  human  race  to  the 
remainder  of  the  animal  world  is  said  to  be  in 
the  power  of  reasoning.  It  is  also  a  matter  of 
popular  belief  that  sheep  are  the  most  stupid 
of  all  animals,  and  any  one  rash  enough  to  com- 
pare the  human  race  to  a  flock  of  sheep  would 
call  down  upon  his  head  a  terrible  storm  of 
indignation  and  abuse  ;  yet  in  some  matters, 
and  more  especially  in  the  matter  of  inebriety, 
it  is  open  to  grave  doubt  whether  we  superior 
beings  have  not  justified  the  comparison.  How- 
ever this  may  be,  let  us  take  a  rapid  survey  of 
the  history  of  inebriety  and  see  how  the  facts 

would  bear  out  such  a  statement. 

I 


2  MODERN  TREATMENT  OF  ALCOHOLISM 

The  ancient  Egyptians  have  left  many  proofs 
of  their  great  advancement  in  civiHsation  in 
various  departments  of  Hfe,  and  it  is  therefore 
not  astonishing  to  find  that  they  recognised  the 
truth  regarding  inebriety,  namely,  that  it  was 
a  disease,  and  treated  it  as  such,  using  such 
remedial  measures  as  lay  to  their  hands.  Among 
these  were  purgatives,  rubbings  or  applications 
to  the  head  and  spine.  Herodotus  wrote  five 
centuries  before  the  birth  of  Christ  that  "  drunken- 
ness showed  that  both  body  and  soul  were  sick." 
Diodorus  and  Plutarch  assert  "  that  drink  mad- 
ness is  an  affection  of  the  body  which  hath 
destroyed  many  kings  and  noble  people."  Many 
of  the  Greek  philosophers  recognised  the  physical 
character  of  inebriety  and  the  hereditary  in- 
fluence or  tendency  which  was  transmitted  to 
the  next  generation.  Greek  laws  were  enacted 
forbidding  women  to  use  wine  and  restricting 
young  boys.  Frequent  reference  is  made  to  the 
madness  which  sought  solace  in  wine  and  spirits, 
and  those  so  afflicted  are  called  upon  and  urged 
to  give  more  diligent  care  to  their  bodies — a 
distinct  hint  of  the  physical  origin  of  inebriety. 

Let  us  now  pass  on  to  the  Christian  era.  In 
the  first  century  we  find  St.  John  Chrysostom 
emphatically  stating  that  inebriety  was  a  disease 
like  dyspepsia.     In  the  next  century,  Ulpian,  the 


WHAT  IS  INEBRIETY  ?  3 

Roman  Jurist,  referred  to  the  irresponsible 
character  of  inebriates,  and  the  necessity  of 
treating  them  as  sick  men.  His  views  were 
embodied  in  some  laws  which  referred  more 
distinctly  to  the  physical  nature  and  treatment 
of  inebriety.  Many  of  the  Roman  writers 
referred  to  the  physical  nature  of  the  disorder. 

Now  comes  a  considerable  gap  in  the  history, 
and  nothing  further  is  recorded  of  this  great 
truth  until  the  thirteenth  century,  when  a  Spanish 
king  enacted  laws  fully  recognising  inebriety  as 
a  disease,  lessening  the  punishment  of  crime 
committed  when  under  the  influence  of  spirits. 
One  of  these  laws  provided  that  when  murder 
was  committed  during  intoxication,  the  death 
penalty  should  be  remitted  and  the  offender 
banished  to  some  island  for  a  period  not  less  than 
six  years. 

After  a  further  lapse  of  three  centuries  we  find 
France  and  some  of  the  German  States  recognis- 
ing inebriety  as  a  disease,  and  enacting  laws 
regulating  the  punishment  of  crime  accordingly. 

In  1747,  Condillac,  a  French  philosopher,  wrote 
clearly  on  the  subject,  asserting  inebriety  to  be 
a  disease,  and  urging  proper  provision  for  its 
treatment.  He  stated  that  the  impulse  to 
drink  was  like  insanity,  an  affection  of  the  brain 
which  could  not  be  reached  by  law  or  religion. 


4  MODERN  TREATMENT  OF  ALCOHOLISM 

Fifty  years  later,  Dr.  Rush  of  Philadelphia 
asserted  the  same  truth,  and  supported  it  by  a 
long  train  of  reasoning.  In  two  essays,  entitled 
"  The  Influences  of  Physical  Causes  upon  Moral 
Faculties,"  and  "  An  Enquiry  into  the  Effects  of 
Ardent  Spirits  upon  the  Human  Body  and  Mind," 
he  described  the  disease  of  inebriety,  dividing 
it  into  "  acute  "  and  "  chronic  "  forms,  giving 
many  causes,  among  which  heredity  was  promi- 
nent. He  urged  the  necessity  of  treatment  in 
hospitals  for  the  purpose.  To  Dr.  Rush  belongs 
the  honour  of  giving  the  first  clear  statement  of 
how  the  disease  should  be  treated. 

During  the  early  part  of  the  nineteenth  century 
four  eminent  continental  physicians.  Dr.  Cabanis 
of  Paris,  Dr.  Salvator  of  Moscow,  Dr.  Esquirol 
and  Dr.  Buhl  Cramner  of  Berlin,  urged  the  true 
nature  of  the  disease,  and  by  their  writings 
placed  the  subject  upon  a  scientific  basis, 
paving  the  way  for  a  proper  study  of  the  disease. 
Since  then  many  writers  have  touched  upon  this 
matter,  recognising  inebriety  as  a  disease,  and 
recommending  its  treatment  as  such. 

The  present-day  idea  of  inebriety  is  interesting 
in  view  of  what  has  been  written  upon  the  sub- 
ject, but  is  one  not  altogether  creditable  to  us  as 
a  profession.  In  spite  of  the  recorded  behefs 
of  the  ancient  Egyptians,  Greeks,  and  Romans, 


WHAT  IS  INEBRIETY  ?  5 

and  the  spasmodic  recognition  here  and  there 
throughout  the  long  centuries  of  the  true  nature 
of  inebriety,  it  is  only  within  comparatively 
the  last  few  years  that  English  physicians  have 
adopted  the  view  of  inebriety  being  a  disease. 
This  is  the  more  astonishing  when  one  considers 
the  multitude  of  cases  open  to  study,  and  the 
fact  that  every  physician  of  even  moderate 
practice  must  have  met  with  numerous  cases. 
I  think  I  may  venture  to  state  that  there  is 
still  a  deplorable  number  of  physicians  in  this 
country  who  stoutly  refuse  to  believe  inebriety 
to  be  a  disease,  and  as  firmly  refuse  to  credit  its 
curability.  If  this  is  so,  and  I  base  the  state- 
ment upon  the  beliefs  expressed  to  myself  by 
many  medical  men  during  the  last  fifteen  years, 
one  cannot  wonder  at  the  views  of  the  laity. 

The  following  incident  will  illustrate  how  the 
question  is  looked  at  by,  I  am  sorry  to  say,  far  too 
large  a  proportion  of  the  populace  of  this  country. 
A  lady  friend  of  mine  once  related  to  me  the 
drunken  habits  of  a  neighbour  of  hers,  and 
when  I  ventured  to  suggest  the  question  of  its 
being  a  disease,  she  became  very  angry,  and 
looking  at  me  with  flashing,  indignant  eyes,  said, 
"  Don't  talk  such  rubbish  to  me  about  such  a 
beast.  If  he  were  my  husband  I  would  horsewhip 
him  or  have  him  placed  in  prison."     I  am  sorry 


6  MODERN  TREATMENT  OF  ALCOHOLISM 

to  say  the  same  lady  later  on  became  a  prey  to 
the  disease  herself.  It  is  unnecessary  to  em- 
phasise further  this  point,  as  every  physician 
probably  knows  it  as  well  as  myself. 

On  this  question  I  have  only  one  view,  namely, 
that  inebriety  is  a  disease,  and,  curiously  enough, 
although  I  have  spent  the  greater  part  of  my 
professional  life  in  the  treatment  of  inebriety,  the 
truth  was  revealed  to  my  mind  long  before  I  was 
a  student  of  medicine.  I  had  been  accustomed 
as  a  boy  to  look  upon  inebriety  as  a  vice,  and 
either  laughed  at  or  pitied  the  victims  as  the 
circumstances  moved  me,  but  one  night  I  was 
making  my  way  to  the  house  of  a  relative,  and 
amused  myself  treading  in  the  zigzag  tracks 
made  by  some  intoxicated  person  in  the  newly 
fallen  snow.  My  interest  in  these  tracks  in- 
creased when  I  found  that  as  I  turned  corner 
after  corner  they  were  always  before  me,  and  as 
I  knew  the  various  residents  in  the  road  where 
my  relative  lived,  finding  them  in  this  road  also, 
I  tried  to  guess  who  the  delinquent  could  be  ; 
but  my  boyish  heart  received  a  great  shock 
when  I  discovered  the  footprints  led  me  through 
the  very  gate  of  the  house  I  was  visiting.  Follow- 
ing them  I  found  my  much-esteemed  and  respected 
relative  sitting  in  an  outbuilding — too  ashamed 
to  enter  his  own  home.     This  man  had  never 


WHAT  IS  INEBRIETY  ?  7 

been  known  to  drink  to  excess  before.  The 
impression  made  on  my  mind  that  night  in- 
fluenced my  whole  career.  I  knew  the  sterUng 
character,  the  iron  will,  of  this  man,  and  I  was 
sorely  troubled  why  this  thing  should  be.  His 
history  revealed  him  as  a  teetotaller  until  he  was 
forty-five.  Typhoid  fever  then  seized  him,  and 
his  doctor  ordered  him  to  convalesce  on  port  wine. 
From  that  time  onward  the  disease  grew  stronger, 
despite  his  frantic  efforts  to  check  it,  and  it  was 
while  watching  the  almost  Titanic  struggles  he 
made  to  overcome  his  weakness  that  the  true 
nature  of  inebriety  flashed  upon  me.  How  well 
I  remember  the  day  I  ventured  to  remonstrate 
with  him  for  drinking,  and  his  reply,  "  My  boy, 
I  would  gladly  give  my  right  hand  to  be  able  to 
overcome  this  accursed  craving  for  drink,"  and 
I  knew  he  spoke  the  truth.  There  can  be  no 
one,  who  has  had  much  to  do  with  such  cases, 
but  has  noticed  the  heroic  struggles  made  by 
many  victims  to  overcome  the  terrible  craving, 
and  is  it  not  pitiful  to  hear  some  friend,  or  even 
some  medical  man,  answer  their  appeal  for  help 
by  telling  them  to  sober  up  and  behave  them- 
selves ? 

For  twenty  years  my  calling  compelled  me  to 
live  with  inebriates.  I  sat  at  the  same  table 
with  them  ;    I  took  part  in  their  recreations  ;    I 


8  MODERN  TREATMENT  OF  ALCOHOLISM 

watched  at  their  bedside  day  or  night ;  I  heard 
their  histories,  received  their  confidences,  and 
studied  their  characters  asleep  or  awake.  The 
result  of  these  twenty  years  of  daily  and  close 
association  with  these  men  and  women  was  an 
overwhelming  amount  of  evidence  in  favour  of 
the  theory  of  disease. 

Let    us    look    at    the    above  -  mentioned    case 

again   for   a   moment.      Here   was   a  man  with 

a    reputation    for    strength    of    character    far 

above  the  average,  and  up  to  the  time  of  his 

illness  he  had  proven  himself  a  man  of  inflexible 

will-power  where   duty  was  concerned — he  had 

everything    to    lose    and    nothing    to    gain    by 

drinking  ;   it  is  rather  absurd  to  ask  us  to  believe 

that  such  a  man  would  deliberately  sacrifice  all 

for    alcohol.       I    have    already    said    that    his 

struggles  were  Titanic,  and  we  will  take  a  look  at 

him  as  he  is  fighting  against  the  disease.     It  is 

early  morning  ;   the  craving  is  upon  him,  and  he 

is   using   his   enormous   will-power   to   overcome 

the  temptation  to  drink.     His  hands  are  clasped 

behind    his    back,    the    finger-nails    tearing    the 

flesh,  and  cold  sweat  is  on  his  brow  while  he 

paces   the    floor.     Backwards    and    forwards   he 

strides,  determined  that  he  will  drop  rather  than 

give  in.     It  is  a  magnificent  fight  of  a  strong 

character  against  the  demon  drink  ;    although  he 


WHAT  IS  INEBRIETY  ?  9 

must  know  that  alcohol  will  beat  him  in  the 
end,  he  is  determined  to  contest  every  inch  of 
the  ground.  It  is  a  noble  struggle,  yet  there  are 
arm-chair  critics  who  will  calmly  tell  you  that  alJ 
alcoholics  can  stop  drinking  whenever  they 
like,  and  they  proclaim  this  from  pulpit  and 
platform !  I  can  imagine  them  among  their 
friends  proudly  referring  to  themselves  as  a 
proof  of  their  statement  that  any  man  can  take 
it  and  leave  it  alone  if  he  wishes  to  do  so.  If  it 
were  not  for  the  harm  they  do,  I  would  pass  them 
by  with  silent  contempt,  merely  pitying  their 
ignorance. 


CHAPTER   II 
PATHOLOGY 

The  Action  of  Alcohol  on  Protoplasm 

The  basis  of  all  animal  life  is  a  substance  termed 
protoplasm.  It  is  composed  of  75  per  cent,  of 
water  and  25  per  cent,  of  solids.  The  latter  is 
a  highly  complex  chemical  compound  of  which  a 
considerable  proportion  is  albumen.  If  the  white 
of  an  egg  is  poured  into  alcohol  it  is  coagulated ; 
the  white  of  an  egg  is  composed  principally  of 
albumen.  If  the  action  of  the  alcohol  is  allowed 
to  proceed  beyond  a  certain  point  the  coagulation 
becomes  permanent.  On  the  other  hand,  if  a 
large  excess  of  water  be  added  before  the  albimien 
is  coagulated  too  firmly,  the  action  is  stopped  and 
the  albumen  redissolved.  From  this  we  may 
infer  that  if  it  were  possible  to  coagulate  all  the 
albumen  in  the  human  body  life  would  become 
impossible. 

The  action  of  alcohol  upon  albumen  is  taken 
advantage  of  in  many  ways.     The  dermatologist 


PATHOLOGY  ii 

when  he  wishes  to  harden  a  section  of  the  skin 
in  order  to  enable  him  to  sHce  it  into  transparent 
films  for  the  microscope,  places  it  in  absolute 
alcohol.  Anatomical  specimens  are  also  preserved 
indefinitely  in  this  way.  Temperance  lecturers 
are  fond  of  coagulating  albumen  in  the  test-tube 
by  means  of  alcohol,  before  their  audiences,  in 
order  to  show  its  effect  upon  the  body,  and  while 
they  are  not  justified  in  inferring  so  much,  such 
experiments  serve  a  useful  purpose.  The  action 
of  alcohol  in  the  human  body  is  very  complex, 
so  many  factors  have  to  be  taken  into  account, 
and  we  are  not  justified  in  claiming  that  which 
science  has  not  proven.  It  is  only  in  late  years 
that  much  progress  has  been  made  in  this  direc- 
tion. If  we  study  the  results  of  these  researches, 
we  find  that  alcohol  has  a  direct  action  on  the 
protoplasm  of  the  living  cell  in  both  plants  and 
animals ;  and  if  we  can  demonstrate  this  we  are 
fully  justified  in  assuming  that  the  same  action 
takes  place  in  the  protoplasmic  cells  of  the  more 
highly  organised  body.  Dr.  Sims  Woodhead  says 
regarding  this  : 

"  Action  of  alcohol  on  protoplasm. — If  we  find 
that  alcohol  exerts  a  definite  action  upon  the 
various  kinds  of  animal  and  vegetable  proto- 
plasm, which  can  be  studied  outside  the  human 
body,   and  if  at  the  same   time   we  can  obtain 


12  MODERN  TREATMENT  OF  ALCOHOLISM 

even  a  small  amount  of  evidence  that  alcohol 
acts  similarly  on  the  human  body,  we  are  justified 
in  assuming  that  the  tissues  of  the  body  react  to 
and  are  injured  by  alcohol  much  as  in  the  case 
of  the  tissues  that  we  can  study  directly,  the 
difference,  if  any,  being  one  of  degree  rather  than 
of  kind. 

"  It  has  sometimes  been  said  that  the  method 
of  study  of  the  action  of  alcohol  on  the  proto- 
plasm or  tissues  of  growing  animals  or  plants 
is  unscientific.  Is  this  the  case  ?  Surely  if 
we  are  to  study  the  effect  of  alcohol  on  the 
tissues  and  organs  of  the  body,  we  must  first, 
if  possible,  determine  the  action  of  alcohol  in 
various  doses  and  in  various  dilutions  upon 
normal  tissues  in  w^hich  we  can,  to  a  certain 
extent,  control  the  conditions  of  the  experiment. 
Indeed,  whilst  it  must  not  be  assumed  that 
certain  substances,  alcohol  amongst  them,  which 
act  as  poisons  to  a  single  kind  of  protoplasm, 
necessarily  act  in  the  same  way  upon  another, 
we  may,  I  think,  accept  it  that,  should  these 
substances  exert  a  deleterious  action  upon  many 
kinds  of  tissues  and  many  kinds  of  protoplasm 
other  than  those  of  the  human  subject,  they  will 
probably  be  poisonous  to  our  more  highly  de- 
veloped tissues.  It  must  be  remembered  that 
experiments  on  this  point  have  been  accmnulating 
for  some  time  back.  I  shall  here  mention  but 
a  few  of  them  as  examples.  J.  J.  Ridge  found 
that  I  part  of  alcohol  in  loo  of  water,  if  used 


PATHOLOGY  13 

to  moisten  geranium  or  grass  seeds,  interferes 
with  their  germination  ;  they  germinate  slowly, 
and  if  the  use  of  this  solution  be  continued,  the 
plants  grow  slowly,  and  the  green  colouring 
matter  (chlorophyll)  on  which  they  depend  for 
their  respiration,  and  partly  for  their  nutrition, 
is  not  formed  in  proper  quantity.  In  the  case 
of  the  geranium,  both  growth  and  chlorophyll 
production  are  so  markedly  affected,  the  i  per 
cent,  solution  interfering  with  growth  so  seriously 
that  at  the  end  of  six  weeks  plants  so  *  watered ' 
are  about  half  the  size  of  control  plants,  in  addi- 
tion to  which  they  are  delicate  and  sickly.  Fresh- 
water organisms,  the  medusa,  and  the  daphnia, 
(water-flea),  are  rapidly  killed  by  a  solution  of 
I  part  of  alcohol  in  4000  of  water.  Then,  again, 
alcohol,  even  in  weak  watery  solution  or  used  as 
a  vapour,  arrests  or  interferes  with  the  develop- 
ment of  the  eggs  of  organisms  so  widely  apart 
in  the  scale  of  animal  life  as  the  blowfly,  the 
frog,  and  the  hen.  Rauber's  experiments  on 
animals  and  plants  are  also  of  interest,  as,  though 
dealing  with  the  same  question  and  in  the  same 
way,  they  are  of  later  date,  and  cover  a  much 
wider  field  than  that  covered  by  any  other 
series  of  experiments ;  moreover,  they  were 
carried  out  independently  of  any  of  the  earlier 
observers.  Rauber  noted  the  influence  of  alcohol 
in  various  strengths  upon  different  plants,  and 
upon  animals  in  various  stages  of  development — 
on  the  hydra,  on  tape-worms,  on  earth-worms, 


14  MODERN  TREATMENT  OF  ALCOHOLISM 

leeches,  crayfish,  various  kinds  of  fish,  the  Mexican 
axolotl,  on  birds  and  mammals,  including  the 
human  subject.  He  found  that  in  lo  per  cent, 
solution,  with  which  he  usually  worked,  alcohol 
acts  as  a  definite  protoplasm  poison,  all  forms  of 
cell  life  upon  which  he  experimented  being  more 
or  less  affected  ;  that  plants  became  shrivelled 
and  etiolated,  that  animals  became  intoxicated, 
and  that  those  who  live  in  water  soon  succumb. 
Crayfish  placed  in  a  2  per  cent,  solution  of  alcohol 
succiunb  in  a  few  hours,  perch  in  a  similar  solution 
rapidly  become  intoxicated,  fall  to  the  bottom 
of  the  vessel  in  which  they  are  placed,  and  die, 
though,  if  they  are  transferred  to  pure  spring 
water  before  death  takes  place  they  may  recover 
in  the  course  of  a  few  hours." 

Some  of  his  experiments  were  carried  out  on 
Bayerinck's  phosphorescent  bacilli,  a  protoplasm 
of  low  organisation,  having  a  definite  and  easily 
measured  activity.  These  experiments  showed 
conclusively  that  alcohol  retarded  the  activity 
of  these  bacilli,  and  he  directs  attention  to  the 
fact  that  this  action  of  alcohol  on  living  proto- 
plasm of  nerve  cells  must  be  far  greater.    He  says  : 

"  It  must  be  remembered  that  we  are  dealing 
with  a  low  form  of  protoplasm,  and  that  the 
function  of  light  production  does  not  require 
anything  like  the  same  complex  conditions 
necessary    for    the    continued    life    and    activity 


PATHOLOGY  15 

of  the  nerve  cell,  and  to  that  extent  it  will  prob- 
ably be  far  more  resistant  to  the  immediate 
action  of  alcohol." 

He  also  refers  to  its  well-known  action  on  the 
protoplasm  of  the  yeast  organism.  As  the  result 
of  his  researches  he  arrives  at  the  following 
conclusions  : 

"  We  may,  then,  accept  it  that  all  protoplasm, 
whether  the  basis  of  animal  or  plant  life,  is 
injuriously  affected  even  by  small  quantities  of 
alcohol,  and  that  under  certain  conditions  there 
is  a  marked  interference  with  nutrition,  pow^r  of 
movement,  and  reproductive  functions,  that  even 
where  immediate  death  of  the  organism  as  a 
whole  does  not  supervene,  marked  degenerative 
changes  result,  the  animal  or  plant  under  these 
conditions  living  on  a  lower  plane  as  regards 
power  of  movement,  nutrition,  and  reproduction 
than  does  the  healthy  organism  into  which  no 
alcohol  has  been  introduced." 


The  Effect  of  Alcohol  on  the  Circulatory 
System 

Its  well-known  effect  upon  the  small  vessels 
is  readily  seen  in  the  telangiectasis  of  the  chronic 
alcoholic,  where  the  paralysing  effect  of  the 
alcohol  upon  the  vaso-motor  nerves  producing 
dilatation   has   through   repetition   become   per- 


i6  MODERN  TREATMENT  OF  ALCOHOLISM 

manent.  It  has  been  noted  that  the  direct 
injection  of  alcohol  into  the  blood  vessels  causes 
dilatation  of  the  vessels  through  which  it  passes. 
That  the  same  takes  place  in  the  small  vessels 
in  the  interior  of  the  body  is  accepted  by  all. 
Regarding  the  changes  which  take  place  in  the 
cells  of  the  blood  vessels,  competent  observers 
have  noted  the  following :  Fatty  degeneration  of 
the  muscular  walls,  subsequent  calcification  pro- 
ducing the  well-known  pipe-stem  variety.  Such 
vessels  are  unsuited  to  resist  sudden  pressures,  and 
may  give  way  under  them.  They  also  are  unable 
to  aid  the  propulsion  of  the  blood  because  of  their 
loss  of  elasticity  and  contraction,  and  thereby 
throw  more  work  upon  the  heart,  causing  dilation 
of  that  organ  with  all  its  attendant  evils.  Its 
irritant  effect  upon  the  vessels  of  the  gastric 
and  hepatic  organs  when  taken  in  moderate 
but  oft-repeated  amounts  is  well  seen  in  the 
post-mortem  room.  The  constant  dilatation 
induces  active  congestion  in  the  surrounding 
tissues,  followed  by  abnormal  nourishment  of  the 
part,  with  its  subsequent  formation  of  fibrous 
tissue,  the  contraction  of  which  causes  com- 
pression and  even  obliteration  of  the  vessels 
themselves.  Its  effect  on  the  heart  is  seen  in 
the  fatty  degeneration  of  the  heart  muscles  and 
subsequent  dilatation.     This  condition  not  only 


PATHOLOGY  17 

follows  excessive  use  of  alcohol,  but  also  moderate 
use,  and  is  one  of  the  factors  in  the  well-known 
excessive  mortality  of  users  of  alcohol  in  some 
diseases  and  operations,  but  other  factors  may 
participate,  and  to  this  I  shall  refer  later  on. 

Regarding  cardio-vascular  changes  due  to 
alcohol,  Dr.  Sims  Woodhead  says  : 

"  In  connection  with  chronic  alcoholism,  most 
physicians  and  pathologists  are  in  agreement 
that  cardio-vascular  disease — that  is,  disease  of 
the  heart,  of  the  blood  vessels,  or  of  both — is  one 
of  the  commonest  causes  of  death.  Moreover, 
it  is  now  generally  recognised,  and  in  this  the 
physicians  are  backed  by  the  physiologists, 
that  the  exhibition  of  alcohol  brings  about  the 
dilatation  of  the  smaller  blood  vessels,  especially 
those  of  smallest  size,  the  capillaries,  a  dilatation 
which  appears  to  be  due  to  a  paralysis  of  the 
nerves  carrying  the  stimuli  that  cause  contraction 
of  the  small  muscles  surrounding  the  blood 
vessels.  Here,  as  elsewhere,  when  there  is  con- 
tinuous or  intermittent  want  of  activity  of 
muscles,  the  result  of  changes  in  the  nerves, 
there  is,  along  with  the  diminished  activity,  an 
impairment  of  the  nutrition  of  the  muscle, 
accompanied  by  some  waste,  or  even  degenera- 
tion, of  this  structure.  We  are  not  surprised, 
therefore,  to  find  that  fatty  degeneration  and 
calcification  of  the  muscular  coat,  already 
described,  is  very  frequently  met  with  in  patients 


i8  MODERN  TREATMENT  OF  ALCOHOLISM 

who  succumb  to  chronic  alcohoHsm.  Moreover, 
wherever  there  is  marked  degeneration  of  tissue, 
as  those  tissues  waste  their  place  is  taken  by 
tissue  of  a  lower  type  —  so-called  connective 
tissues  or  scar  tissue.  The  muscular  coat  of  the 
vessel  forms  only  part  of  the  vessel  wall,  but  it 
will  be  found  that  wherever  it  is  affected  the 
inner  coat,  as  well  as  an  outer  covering  of  con- 
nective tissue,  are  also  as  a  rule  considerably 
altered.  Without  attempting  to  give  any 
special  account  or  classification  of  the  changes 
that  take  place  in  the  vessels  as  a  result  of 
chronic  alcoholism,  I  may  say  that  in  most  cases 
evidences  of  its  poisonous  action  may  be  met 
with  in  the  vessels,  large  and  small  alike. 

"  In  old  people  it  is  difficult  to  trace  the  cause 
of  these  degenerative  changes,  but  in  apparently 
young  people  who  have  suffered  from  chronic 
alcoholism  it  is  usually  fairly  easy  to  demon- 
strate the  connection  between  cause  and  effect ; 
and  it  is  my  experience  that  in  certain  cases 
where  I  have  been  able  to  observe  certain 
changes  in  the  walls  of  the  blood  vessels,  especi- 
ally where  I  have  been  able  to  make  out  some 
pathological  condition  in  every  part  of  the 
vessel  wall,  I  have  been  able  to  eliminate  all 
causes  but  chronic  alcoholism,  of  which,  therefore, 
I  look  upon  the  thickened  vessels  in  the  various 
organs  and  tissues  of  the  body  (in  these  com- 
paratively young  people)  as  the  direct  result. 
These  changes  appear  to  arise  from  a  proliferation 


PATHOLOGY  ig 

of  the  connective-tissue  cells,  and,  secondly,  from 
the  accumulation  of  waste  products,  or  even  in 
some  cases  of  tissue  debris  in  the  tissue  spaces, 
consequent  upon  which  there  is  an  invasion  of 
these  spaces  by  leucocytes  or  scavenging  cells. 

"  Wherever  this  is  marked,  there  is  always  a 
further  increase  of  large  cells  that  help  to  form  a 
fibrous  or  scar  tissue.  In  certain  cases  these  pro- 
cesses proceed  slowly  and  steadily,  and  at  no  time 
does  there  appear  to  be  any  great  amount  of  new 
cellular  tissue  formed  ;  there  is  simply  a  gradual 
but  continued  increase  in  the  amount  of  scar  tissue. 
This  increase  is  almost  invariably  accompanied 
by  some  form  of  degeneration  in  the  special 
tissues  of  the  organ  in  which  the  process  is  going 
on.  The  stages  of  this  process  are  well  illustrated 
in  the  changes  that  take  place  in  inflammation  of 
the  liver.  First,  there  is  at  one  extreme  an  acute 
inflammation,  characterised  by  dilatation  of  the 
blood  vessels,  numerous  scavenging  cells,  and  a 
gradually  increasing  number  of  the  larger  scar- 
tissue-forming  cells,  whilst  at  the  other  extreme  is 
the  chronic  alcoholic  cirrhosis,  the  hob-nail  or  gin- 
drinker's  liver,  in  which  the  scar  tissue  seems  in 
many  cases  to  be  formed  almost  directly,  though 
on  careful  examination  it  will  be  found  that  here 
and  there,  as  in  the  acute  process,  there  is  usually 
some  evidence  of  the  cellular  origin  of  the  new 
tissues,  and  also  of  the  presence  of  a  number  of 
the  scavenging  cells — certain  indications  of  the 
presence  of  an  irritant,  and  probably  also  of  the 


20  MODERN  TREATMENT  OF  ALCOHOLISM 

accumulation  of  waste  products  in  the  tissues. 
Moreover,  in  this  condition  of  gin-drinker's  liver, 
as  the  scar  tissue  increases  in  quantity,  so,  as  in 
the  case  of  the  muscular  coat  of  the  blood  vessel, 
the  liver  cells  waste  away  and  undergo  fatty 
degenerative  changes ;  in  some  cases  they 
disappear  altogether,  the  fibrous  tissue  advancing 
and  gradually  replacing  them.  Whether  this 
scar-tissue  formation  goes  on  in  the  heart,  in  the 
kidneys,  in  the  liver,  in  the  blood  vessels,  or  in 
the  nerves,  the  process  is  essentially  the  same. 
It  must  be  associated  with  the  accumulation  of 
poisonous  and  waste  products  in  the  small 
spaces  through  which  the  nutrient  fluid  passes  to 
the  tissues,  and  must  also  be  associated  with 
marked  disturbance  of  functional  activity. 
Wherever  such  conditions  are  present,  the 
changes  in  structure  assume  greater  or  less 
proportions,  according  as  the  organ  or  tissue  in 
which  these  changes  are  met  with  plays  a  more 
or  less  important  part  in  carrying  on  the  nutrition 
of  the  body,  or  in  determining  the  nervous  or 
muscular  activity.  Moreover,  it  must  be  re- 
membered that  in  all  cases  the  most  highly 
developed  cells  are  first  affected,  and  that,  as 
these  become  wasted  and  degenerated,  new 
tissue,  never  highly  developed,  and  often  of  very 
low  type  of  tissue — corresponding  to  the  white  scar 
tissue  that  one  sees  in  an  old  wound — comes  to 
take  their  place  ;  indeed,  the  contraction  of  the 
old  scar  tissue  of  a  wound  has  its  exact  homo- 


PATHOLOGY  21 

logue   in   the   contracting   scar   tissue   met  with 
in  the  liver,  in  the  kidney,  and  in  the  brain." 


Gastro-Intestinal  Tract 

The  effect  of  alcohol  on  the  mucous  membrane 
is  the  same  as  its  effect  on  the  skin  ;  in  addition 
it  seems  to  increase  the  muscular  activity  of  the 
stomach  so  as  to  cause  its  contents  to  be  expelled 
into  the  duodenum.  If  the  alcohol  is  given  in 
concentrated  form  its  action  is  more  marked. 
If  given  in  large  quantities  and  concentrated,  it 
diminishes  the  amount  of  gastric  and  pancreatic 
secretions ;  but  if  given  in  small  quantities  and 
well  diluted,  it  is  said  to  increase  the  flow  of 
the  secretions  (Bernard  and  others).  In  large 
quantities  alcohol  has  a  distinctly  retarding  effect 
on  the  activity  of  the  salivary,  gastric,  and  pan- 
creatic ferments  (W.  Hale  White).  Authorities 
differ  as  to  the  amount  necessary  to  effect  this 
retardation ;  some  place  it  as  low  as  2  per  cent., 
while  Sir  William  Roberts  states  that  this  re- 
tardation of  the  salivary  and  gastric  secretions 
does  not  take  place  until  40  per  cent,  of  proof 
spirits  is  present,  and  in  the  case  of  pancreatic 
secretion  that  20  per  cent,  is  necessary  to  arrest 
digestion.  So  far  as  the  gastric  secretion  is 
concerned,  it  is  thought  by  some  that  this  re- 


22  MODERN  TREATMENT  OF  ALCOHOLISM 

tardation  is  due  to  the  precipitation  of  the  pepsin. 
Hale  White  says  regarding  this  : 

"  The  long  -  continued  action  of  alcohol, 
especially  in  excessive  quantities,  on  the  gastric 
mucous  membrane  causes  catarrh,  and  the 
stomach  becomes  coated  with  a  thick  tenacious 
mucus,  and  digestion  is  thus  greatly  hampered, 
the  food  in  the  stomach  undergoing  fermentation 
and  decomposition.  In  addition  to  a  direct 
action  on  the  mucous  membrane,  alcohol  may 
cause  fatty  degeneration  of  the  muscular  tissues, 
amongst  others  the  muscular  coat  of  the  stomach, 
and  in  this  way  produce  dilatation  of  the  stomach 
which  still  further  hampers  digestion.  Alcohol 
may  aid  digestion  indirectly,  owing  to  its  solvent 
action  on  fat.  The  action  of  alcohol  on  the 
stomach,  therefore,  is  mixed,  since  it  is  probable 
that  it  has  a  stimulating  effect  by  its  direct 
action  on  the  mucosa  and  so  may  aid  digestion, 
in  addition  to  helping  this  process  by  causing 
the  propulsion  of  the  gastric  contents  into  the 
intestine  and  by  increasing  the  gastric  juice  if 
the  alcohol  is  dilute.  The  increased  secretion 
of  saliva  produced  may  also  aid  gastric  digestion, 
as  saliva  is  a  most  efficient  excitant  of  the  gastric 
secretion.  On  the  other  hand,  there  is  no  doubt 
evidence  that  if  it  be  administered  in  large 
quantities,  and  especially  if  concentrated,  it 
retards  digestion,  checking  the  activity  of  the 
gastric  glands  and  the   action  of  the   digestive 


PATHOLOGY  23 

ferments.  Alcohol  is  absorbed  rapidly  from  the 
digestive  tract,  and  it  also  increases  the  rate  of 
absorption  of  other  substances,  as  can  be  shown 
in  the  case  of  iodide  of  potassium." 


Effect  on  the  Brain  and  the  Nervous 
System 

Dehio  and  Berkley  have  both  carried  out 
experiments  on  acute  alcoholism  in  the  lower 
animals.  They  both  noticed  marked  degenera- 
tive changes  in  the  lining  membrane  of  the  small 
vessels  of  the  brain,  whilst  in  the  spaces  surround- 
ing the  vessels  evidence  was  found  of  what  Berk- 
ley calls  an  exaggerated  condition  of  waste,  a 
"  clogging  "  due  to  the  accumulation  of  rapidly 
produced  waste  products.  Before,  then,  w^e  come 
to  the  nerve  cells,  the  proper  cells  of  the  brains, 
we  find  marked  changes  occurring  in  the  vessel 
walls  and  in  the  spaces  surrounding  them.  In 
some  cases  small  clots  are  formed  in  the  vessels — 
clots  which  interfere  with  the  transmission  of  the 
blood  along  the  normal  channels.  This  clogging 
of  the  vessels  and  of  the  spaces  around  affords 
evidence  of  a  very  active  breaking  down  of  the 
tissues,  but  it  is  still  more  important  as  a  cause 
of  continued  interference  with  the  nutrition 
of  the  surrounding  tissues,  thus  playing  a  part 


24  MODERN  TREATMENT  OF  ALCOHOLISM 

in  the  determination  of  further  degeneration  and 
breaking  down  of  the  surrounding  tissues.  With 
reference  to  the  effect  of  alcohol  in  the  brain 
cells,  Dr.  Sims  Woodhead  says  : 

"  Under  the  action  of  considerable  doses  of 
alcohol,  just  as  under  the  action  of  large  doses  of 
diphtheria  toxin,  remarkably  definite  and  readily 
recognisable  changes  may  be  demonstrated  in 
the  nerve  cells  of  both  man  and  the  lower  animals, 
especially  those  near  the  plugged  vessels  and 
lymph  spaces  already  referred  to.  The  nerve 
cell  first  loses  its  pecuHar  mottled  appearance, 
and  then  swells  up.  In  the  small  branches  that 
are  given  off  from  the  long  processes  leading  out 
from  these  cells  very  characteristic  changes  may  be 
seen — changes  indicating  that  profound  modi- 
fications have  taken  place  in  them,  the  result  of 
the  action  of  the  poison.  They  are  never  met 
with  in  the  healthy  human  brain,  nor  are  they 
found  in  the  brains  of  healthy  animals.*' 

And,  again,  he  says  with  regard  to  its  action 
upon  the  nerve  fibres  : 

"  First  of  all,  in  these  toxic  conditions  the 
outer  covering  breaks  down  ;  then  after  a  time 
the  central  core  corresponding  to  the  wire — the 
axis  cylinder  as  it  is  called— becomes  irregularly 
thickened  and  thinned  alternately,  so  that, 
instead  of  a  solid  rod  of  equal  thickness,  we  have 


PATHOLOGY  25 

something  almost  like  a  string  of  beads.  Wher- 
ever this  irregular  thickening  is  produced,  the 
impulses  are  irregularly  transmitted  along  the 
nerves,  and  the  patient  finds  that  his  experience 
is  no  longer  to  be  relied  upon  ;  he  is  thoroughly 
at  fault,  he  is  unable  to  translate  the  sensations 
irregularly  transmitted  by  these  altered  nerves, 
and  he  is  unable  to  keep  his  various  muscles 
under  control,  simply  because  his  experience 
no  longer  informs  him  what  force  he  should 
send  along  a  certain  nerve  in  order  to  bring  about 
the  required  stimulation  of  a  muscle  or  group  of 
muscles.  It  has  been  pointed  out,  however,  that, 
in  addition  to  these  changes  in  the  actual  nerve 
fibres,  there  is,  in  alcoholic  poisoning,  an  increase 
in  the  amount  of  fibrous  tissue  formed  between 
them,  just  as  around  the  small  vessels  of  the  liver 
and  certain  other  organs." 


The  Effect  of  Alcohol  on  Phagacytosis 

There  is  such  an  excellent  account  of  this  by 
Dr.  Sims  Woodhead,  that  1  have  taken  the 
liberty  of  quoting  it  fully  here  from  his  recent 
lecture  on  the  subject : 

"  Recent  bacteriological  research  has  enabled 
us  to  throw  a  clear  light  on  alcohol  in  relation 
to  the  specific  infective  diseases.  Numerous 
workers,  following  up  the  lead  given  by  Abbott, 
have    accumulated    much     evidence    that    alco- 


26  MODERN  TREATMENT  OF  ALCOHOLISM 

holised  patients  and  animals  are  more  readily 
attacked  by  these  various  febrile  diseases — 
inflammation  of  the  lungs,  erysipelas,  typhoid 
and  other  fevers  —  than  are  non  -  alcoholised 
patients.  Dr.  Delearde's  experiments  have  been 
very  frequently  quoted,  but  they  are  so 
important  that  I  do  not  apologise  for  again 
bringing  them  forward.  This  observer  wished 
to  determine  whether  and  how  alcohol  weakens 
the  resisting  powers  of  the  body,  and  if  it  does, 
what  are  the  factors  by  which  any  such  weaken- 
ing may  be  brought  about.  Many  of  you  may  be 
aware  that  it  is  possible  to  protect  animals  against 
severe  attacks  of  certain  diseases  by  the  pro- 
duction in  them  of  mild  attacks  of  the  same 
diseases.  A  child  that  has  suffered  from  scarlet 
fever  seldom  contracts  that  disease  a  second 
time,  and  a  patient  who  has  had  small-pox  or 
typhoid  fever  is  usually  immune  against  a  second 
attack.  For  his  experiments  Delearde  selected 
three  diseases — rabies  or  hydrophobia,  tetanus 
or  lockjaw,  and  anthrax  or  splenic  fever  of 
cattle.  In  tetanus  and  anthrax  the  specific  micro- 
organism producing  the  disease  has  been  described, 
and  in  all  three  cases  a  diminished  susceptibility 
or  artificial  immunity  had  been  induced.  All 
three  diseases  may  be  induced  in  acute  and 
fatal  form,  or,  if  the  virus  be  weakened  by  special 
methods,  a  milder  attack,  which  under  ordinary 
circumstances  protects  the  animals  against  more 
severe  attacks  of  the  disease,  may  be  produced. 


PATHOLOGY  27 

"  Using  rabbits,  he  gave  to  each  of  a  certain 
number  of  them  a  quantity  of  alcohol,  com- 
mencing with  about  ij  drachms,  and  gradually 
increasing  the  dose  to  2|  drachms  a  day.  This 
quantity  of  alcohol  undoubtedly  interfered  with 
the  nutrition  of  the  rabbits,  as  its  administration 
was  followed  by  '  slight  falling  off  of  weight ; 
but  after  a  time  this  fall  ceased,  and  then  the 
animal  gradually  got  to  its  normal  weight/  It 
accommodated  itself  to  the  new  conditions,  as 
it  were  ;  but  although  it  was  restored  to  its 
normal  weight,  very  marked  changes  had  taken 
place  in  its  fluids  and  tissues.  Having  prepared 
his  alcoholised  animals,  several  non-alcoholised 
animals  were  *  vaccinated  '  against  hydrophobia. 
After  they  had  acquired  a  considerable  degree 
of  immunity — that  is,  when  they  were  no  longer 
very  susceptible  to  the  hydrophobia  poison — 
alcohol  was  administered  to  them  as  above. 
They  were  then  injected  with  what,  under 
ordinary  circumstances,  would  be  a  fatal  dose 
of  the  hydrophobia  poison.  All  the  animals 
remained  alive.  The  tissue  had  become  less 
susceptible  owing  to  the  vaccination,  and  so 
firmly  rooted  was  this  diminished  susceptibility 
that  alcohol  was  not  able  to  interfere  with  it. 
The  animal  remained  immune. 

"  He  then  carried  out  a  second  series  of  experi- 
ments, the  procedure  for  the  production  of  im- 
munisation being  carried  out  as  before,  with  this 
difference,  that  whilst  it  was  going  on  the  animal 


28  MODERN  TREATMENT  OF  ALCOHOLISM 

received  alcohol  in  the  quantities  mentioned 
above.  Here  the  result  was  most  unexpected 
and  startling.  No  immunity  was  produced  ; 
the  animal  remained  just  as  susceptible  to  the 
disease  as  if  no  attempt  had  been  made  to  vaccinate 
it.  The  alcohol  so  interfered  with  the  reaction 
between  the  vaccine  and  the  tissues  that  no 
immunity  was  produced.  Carrying  the  experi- 
ment a  step  further,  he  took  one  of  the  animals 
to  which  he  had  been  giving  alcohol  for  some  time, 
and,  discontinuing  the  alcohol,  he,  after  a  few 
days,  vaccinated  with  hydrophobia  virus.  He 
now  found  that  a  certain  degree  of  protection 
was  conferred.  Here,  however,  the  protection 
was  not  so  marked  as  in  the  case  where  no  alcohol 
had  been  given  at  any  stage. 

"  These  experiments  satisfied  him  that  acute 
alcoholism  has  the  effect  of  preventing  the 
acquisition  of  a  condition  of  immunity.  The 
effect  of  alcohol  on  the  tissue  cells  is  not  so 
marked,  however,  that  w^hen  its  administration 
is  stopped  they  cannot  regain  some  of  their 
original  powers  and  properties.  Further,  when 
the  property  of  immunity  has  been  acquired 
before  alcohol  is  given,  the  cells  retain  this 
property  even  in  the  presence  of  considerable 
quantities  of  alcohol.  In  the  case  of  tetanus  or 
lockjaw,  however,  alcohol  exerts  a  much  more 
serious  effect,  for  even  animals  that  have  been 
vaccinated  against  lockjaw,  when  alcoholised, 
lose  their  insusceptibility  to  the  disease,  and  may 


PATHOLOGY  29 

be  readily  infected,  in  this  differing  markedly 
from  animals  vaccinated  against  hydrophobia. 
Rabbits  vaccinated  against  lockjaw  and  simul- 
taneously alcoholised  do  not  acquire  immunity 
at  all  readily  ;  under  these  conditions  it  is  very 
difficult  to  protect  them  against  the  lockjaw 
poison.  Here,  however,  as  in  the  case  of  hydro- 
phobia, animals  first  alcoholised  and  then  vaccin- 
ated against  lockjaw  may  acquire  an  insus- 
ceptibility to  the  lockjaw  if  the  alcohol  be  stopped 
as  soon  as,  or  before,  the  process  of  vaccination 
is  begun. 

"  It  is  evident  from  these  experiments  that  even 
after  immunity  has  been  acquired  alcohol  may 
destroy  it,  a  fact  which  must  be  remembered 
in  connection  with  treatment.  Whenever  a 
patient  is  recovering  from  an  attack  of  one  of 
the  specific  infective  diseases,  he  recovers,  be- 
cause, during  the  course  of  the  disease,  he  has 
acquired  a  certain  specific  immunity,  the  result 
of  changes  in  the  tissues  and  fluids  of  the  body. 
H  alcohol  impairs  this  immunity  in  any  way, 
or  interferes  with  its  production,  the  patient's 
chance  of  recovery  must  necessarily  be  dimin- 
ished. Continuing  his  experiments,  Delearde 
found  that  it  was  almost  impossible  to  confer 
immunity  against  anthrax  if  the  animals  were 
alcoholised  during  the  period  that  they  were 
being  vaccinated,  and  although  animals  first 
alcohohsed  for  a  period  and  then  vaccinated — 
the  alcohol  being  stopped  during  the  period  of 


30  MODERN  TREATMENT  OF  ALCOHOLISM 

vaccination,  as  in  the  case  of  hydrophobia  and 
lockjaw — acquire  a  certain  degree  of  immunity, 
they  rapidly  lose  condition  when  infected.  They 
certainly  suffer  more  severely  than  do  the  non- 
alcohohsed  animals  vaccinated  at  the  same  time 
and  infected  in  the  same  manner. 

"Delearde  points  out  that  chnical  experience 
bears  out  these  experiments.  Indeed,  his  atten- 
tion was  first  directed  to  this  subject  by  observa- 
tions on  an  alcohohc  patient  bitten  by  a  mad 
dog.  This  patient  appeared  to  be  much  more 
susceptible  to  the  action  of  hydrophobia  poison 
than  a  second  patient  bitten  and  inoculated 
under  otherwise  much  less  favourable  conditions. 
The  first  case  was  that  of  a  man  of  thirty  years 
of  age,  of  intemperate  habits,  who  was  bitten 
on  the  hand  by  a  dog.  Though  carefully  sub- 
jected to  a  complete  antirabic  treatment,  he 
succumbed.  The  other  case  was  that  of  a  child, 
aged  thirteen  years,  who,  on  the  same  day,  was 
bitten  on  the  face  by  the  same  dog.  The  course 
of  antirabic  treatment  was  exactly  the  same,  but 
here,  although  the  bite  was  more  severe  and  its 
position  more  dangerous  —  the  head  and  face 
being  the  most  dangerous  positions  in  which  a 
patient  can  be  bitten — the  child  recovered.  In 
comparing  these  two  cases,  the  only  factor  that 
seemed  to  be  more  unfavourable  in  the  case  of 
the  man  than  in  that  of  the  child  was  the  in- 
temperate habits  of  the  former,  who  took  alcohol 
even  during  the  period  of  treatment.     Delearde 


PATHOLOGY  31 

was  so  strongly  impressed  with  what  he  saw  in 
the  wards  and  in  his  experiments,  that  he  strongly 
advises  patients  who  have  been  bitten  by  mad 
dogs  to  abstain  from  the  use  of  alcohol,  not  only 
during  the  actual  process  of  treatment,  which 
is  carried  out  for  the  purpose  of  producing  an 
active  immunity  against  the  hydrophobia  poison, 
but  also  for  a  period  of  at  least  eight  months 
afterwards,  during  which  time  there  appears  to 
be  a  steady  and  persistent  increase  of  immunity. 

"  Another  most  remarkable  series  of  experiments 
are  those  of  Laitinen  of  Helsingfors.^  These 
were  carried  out  in  Professor  Fraenkel's  patho- 
logical laboratory  at  Halle,  and  were  in  great 
part  supervised  and  controlled,  or  at  any  rate 
observed,  by  the  Professor.  They  are  perhaps 
of  even  greater  importance  than  those  already 
quoted,  from  the  fact  that  much  smaller  doses  of 
alcohol  were  used  than  in  either  Abbott's  or 
Delearde's  experiments.  The  dose  for  each 
animal  was  calculated  and  based  on  the  amount 
given  as  a  nutrient  substance,  or  a  medicine,  or 
both,  in  a  well-known  sanatorium  at  Davos. 
This  worked  out  at  from  4  to  6  drops  to  every 
pound  weight  of  the  rabbit  used.  Laitinen 
was  careful  to  keep  well  within  this  quantity, 
and  to  use  the  aclohol  in  a  well-diluted  form. 
It  was  given  over  long  periods — weeks  or  even 
months  before  the  final  part  of  each  experiment 

^  Ac^a  Soc.  Sc.  Fetmicce,  1 890,  Helsingfors,  1900,  t.  xxix. 
No.  7. 


32  MODERN  TREATMENT  OF  ALCOHOLISM 

was  commenced — and  its  use  was  continued 
for  some  time  after  the  experiment  had  been 
going  on.  He  also  performed  a  series  of  experi- 
ments on  animals  to  which  doses  of  alcohol 
large  enough  to  produce  acute  alcohol-poisoning 
were  given. 

"  Into  animals  so  prepared  he  introduced  the 
bacilli  of  splenic  fever,  tubercle  bacilli — the 
bacilli  of  consumption — and  the  poison  produced 
by  the  diphtheria  bacillus.  The  dose  of  the 
virus  or  poison  was  in  each  case  very  carefully 
measured,  both  as  regards  virulence,  number  of 
bacilli,  and  quantity  of  poison.  As  the  result 
of  numerous  experiments,  he  was  convinced  that 
alcohol,  whether  introduced  subcutaneously  or 
by  the  stomach,  induces  in  the  animal  body  an 
increased  susceptibility  to  infection  by  the 
organisms  with  which  he  worked,  or  to  poisoning 
by  their  toxin. 

"  Abbott,  Delearde,  and  Laitinen,  supported  by 
Fraenkel,  Calmette,  Pearce  Gould,  and  others, 
draw  the  practical  conclusion  that  physicians 
and  surgeons  often  commit  a  grave  error  in  ad- 
ministering even  comparatively  small  doses  of 
alcohol  to  patients  suffering  from  the  special 
diseases  with  the  viruses  of  which  these  various 
experiments  were  made.  It  is  also  agreed  that 
in  certain  other  infectious  diseases — such  as 
pneumonia — or  intoxications  such  as  that  pro- 
duced by  a  snake-bite,  the  use  of  alcohol  is  not 
merely  useless,  but  often  actually  harmful. 


PATHOLOGY  33 

"  Some  of  the  earlier,  and  even  some  later, 
observers  were  of  the  opinion  that  the  diminished 
resistance  noted  in  the  above  experiments  must 
be  the  outcome  of  abnormal  conditions  in  the 
various  organs — alimentary  canal,  liver,  kidneys, 
heart,  nervous  system,  etc. — or  that  it  might 
be  due  to  a  kind  of  starvation,  in  which  condition 
animals  are  undoubtedly  more  susceptible  to  the 
attacks  of  infective  fevers.  This  explanation, 
however,  though  accounting  for  some  of  the 
phenomena  observed,  is  not  sufficient  to  account 
for  all. 

"  In  pneumonia  and  snake-bite,  wherever  re- 
covery takes  place,  there  is  an  increase  in  the 
number  of  leucocytes  or  white  blood  corpuscles 
in  the  part  affected,  and  this  increase  appears  to 
be  a  necessary  factor  in  the  cure  of  the  patient. 

"  Delearde  insists  that  it  is  necessary  that,  in 
all  microbic  infections  or  intoxications,  the 
integrity  of  the  leucocytes  should  be  carefully 
maintained.  In  the  presence  of  alcohol,  just 
as  in  the  case  of  opium-poisoning — as  pointed 
out  by  Metchnikoff  and  his  pupils — this  integrity 
is  not  maintained.  Two  Belgian  observers, 
Massart  and  Bordet,^  in  carrying  out  experiments 
on  the  attraction  and  repulsion  of  the  living 
leucocytes  by  various  bodies,  found  that  alcohol, 
even  in  very  dilute  solution,  strongly  repels 
leucocytes,  driving  them  away  from  its  neigh- 

^  Journ.    de  Med.,    de   Chirur.  et  de  Pharfnac,    Bruxelles,   20 
fevrier,  1900;  Ann.  de  Vlnst.  Pastettr,  Paris,  1891,  t.  v.  p.  417. 

3 


34  MODERN  TREATMENT  OF  ALCOHOLISM 

bourhood.  If,  then,  we  have  alcohol  circulating 
in  the  blood,  even  in  very  minute  quantities, 
the  leucocytes  do  not  make  their  way  into  the 
blood  at  all  readily,  and  therefore  cannot  be 
carried  from  place  to  place.  Alcohol  thus 
prevents  the  white  cells  or  leucocytes  from  coming 
up  to  attack  invading  organisms  ;  it  also  assists 
other  poisonous  substances  that,  in  more  or  less 
concentrated  form,  have  the  power  of  repelling 
leucocytes,  the  two  substances  acting  cumula- 
tively, and  driving  away,  or  in  certain  cases 
paralysing,  these  white  cells  of  the  blood.  How 
important  this  is  may  be  gathered  from  the  fact 
that  the  leucocytes  appear  to  act  as  a  kind  of 
sanitary  police  force.  They  make  their  appear- 
ance wherever  dead  matter  is  to  be  removed  ; 
they  attempt  to  prevent  the  invasion  of  disease- 
producing  organisms,  and  once  they  come  to 
grips  with  their  opponents,  they  will  die  rather 
than  give  way.  Their  work  is  so  important, 
however,  that  if  their  opponents  are  too  strong 
they  often  attempt  to  keep  out  of  their  way  for 
a  time  until  they  are  weakened,  or  they  have 
had  time  to  prepare  themselves  for  the  fight. 
As  the  presence  of  alcohol  is  a  new  factor,  and 
certain  disease-producing  organisms,  getting  into 
the  tissue  of  animals  and  patients  during  the  time 
that  alcohol  is  holding  back  the  leucocytes, 
meeting  with  no  resistance,  set  up  a  severe  attack 
of  the  disease,  the  organisms  obtain  such  a  foot- 
hold that  the  leucocytes  are  never  able  to  drive 


PATHOLOGY  35 

them  out.  This,  however,  is  only  one  of  the 
factors  to  be  taken  into  consideration. 

"  In  all  diseases,  then,  in  which  leucocytes  help 
to  repel  or  remove  the  invading  organisms,  or 
in  which  they  retain  their  power  of  reacting  to, 
or  of  carrying  on  their  functions,  in  the  presence 
of  toxins,  we  should  expect  that  alcohol  would 
deprive  them  of  some  of  this  power,  or  interfere 
with  the  acquisition  by  these  cells  of  a  greater 
resisting  power.  Alcohol,  then,  in  the  first  place, 
interferes  with  the  reactions  of  the  cells  to  poison, 
thus  interfering  with  the  production  of  immunity  ; 
beyond  this,  it  reinforces  the  poison  formed 
by  the  disease-producing  organisms,  often  with 
results  most  disastrous  to  the  patient. 

"  Another  factor  in  this  action  of  alcohol  in 
increasing  the  susceptibility  to  disease  is  un- 
doubtedly its  power  of  interfering  with  nutrition, 
especially  of  young,  unstable,  or  highly-organised 
tissues — its  action  on  young  children  and  young 
animals,  unborn  or  born,  is  now  fully  recognised  ; 
and,  secondly,  of  lowering  the  temperature, 
especially  when  given  in  what  may  be  called 
poisonous  doses.  When  large  doses  of  alcohol 
are  given,  the  temperature  is  lowered  beyond 
the  normal,  and  during  this  temporary  lowering 
of  temperature  the  body  seems  to  be  specially 
susceptible  to  the  attacks  of  infective  agents. 
Pembrey,!  one  of  the  authorities  on  this  subject, 
has  pointed  out  that  the  fall  in  temperature  is 

^  In  Schafer's  Text-book  of  Physiology,  1900,  vol.  ii.  p.  53. 


36  MODERN  TREATMENT  OF  ALCOHOLISM 

due  to  increased  vascularity  of  the  skin  and 
increased  activity  of  the  sweat  glands,  the 
normal  reaction  to  cold  being  paralysed  by  large 
doses  of  alcohol. 

"  Most  authorities  agree  that  alcohol  taken  in 
small  quantities  causes  only  a  slight  lowering 
of  temperature — less  than  half  a  degree  ;  but 
when  considerable — that  is,  poisonous — doses  are 
given  the  effect  is  much  more  marked.  The 
lowest  temperatures  recorded  during  life  are 
observed  in  drunken  persons.  The  temperature 
of  a  normal  rabbit  exposed  to  cold  falls  only 
about  5°  F.,  whilst  the  temperature  of  an  alco- 
holised  rabbit  may  fall  as  much  as  34°  F. 
Similarly,  the  fall  in  temperature  of  a  normal 
guinea-pig  exposed  to  cold  is  only  from  0*2° 
to  0*36°  F.  ;  of  an  alcoholised  guinea-pig  exposed 
in  the  same  way  it  may  be  as  much  as  18°  F. 
Now,  Pasteur  found  that,  by  placing  a  hen  with 
its  feet  in  cold  water,  and  thus  lowering  its 
temperature,  he  could  render  it  susceptible  to 
anthrax,  though  up  to  that  period  those  who  had 
worked  with  this  disease  had  been  unable  to 
produce  anthrax  in  the  hen.  Similar  observa- 
tions have  since  been  made  by  other  observers. 

"  We  must,  however,  look  beyond  this  factor  of 
temperature  in  our  search  for  predisposing  causes. 
Not  only  the  cells  of  the  body,  but  the  fluids  in 
which  these  cells  are  carried,  and  which  give 
material  to,  and  receive  waste  or  other  excreted 
products  from  them,  play  an  important  part  in 


PATHOLOGY  37 

resisting  disease.  It  has  been  demonstrated  by 
Ehrlich,  Myers, ^  and  other  workers  on  this  line 
of  investigation,  that  the  introduction  of  certain 
substances  into  the  body  modifies  its  fluids  in  a 
most  remarkable  manner.  For  example,  if  egg 
albumen  be  introduced  into  the  abdominal 
cavity  of  the  rabbit,  it  is  taken  up  into  the 
blood,  and  in  the  process  of  assimilation  by  the 
body  it  appears  to  affect  the  cells  in  such  a 
fashion  that  they  secrete  something  into  the 
blood  that,  added  to  egg  albumen  in  solution 
outside  the  body,  causes  its  precipitation. 

**  Uhlenhuth,^  extending  the  scope  of  these 
experiments,  found  that  the  blood  serum  from 
an  animal — ox,  sheep,  etc. — when  introduced 
into  a  rabbit  brought  about  the  production  of 
some  substance  in  the  blood  of  that  rabbit  that, 
when  added  to  the  blood  serum  with  which 
the  rabbit  was  first  injected,  threw  down  a 
precipitate  which  could  be  readily  measured. 
Nuttall,^  continuing  this  work,  found  that  by 
this  method  it  was  possible  to  distinguish  the 
blood  of  different  species  of  animals — human 
blood  from  cow's  blood,  dog's  blood  from  sheep's 
blood,  and  so  on.  Further,  w^hen  the  red  blood 
corpuscles  of  one  animal  are  introduced  into  the 
abdominal  cavity  of  another  species,  it  is  found 
that  if  a  drop  of  blood  be  taken  from  the  ear  of 

^  Lancet,  London,  1900,  vol.  ii.  p.  98. 

^  Deutsche  Med.  IVochenschr.,  Leipzig,  I90i,jahrg.  xxvii.  S.  82. 

^  JouYH.  of  Hyg.,  Cambridge,  1901,  vol.  i.  p.  367. 


38  MODERN  TREATMENT  OF  ALCOHOLISM 

the  second  animal  and  added  to  the  blood  of  the 
first  there  is  a  breaking-down  of  the  red  blood 
corpuscles  in  the  first  blood.  Alcohol  appears  to 
interfere  with  certain  of  these  processes  connected 
with  the  breaking-down  of  blood  (hsemolytic 
processes)  or  to  accelerate  them.  As  in  the 
case  of  the  production  of  immunity,  so  in  the 
case  of  haemolysis  or  breaking-down  of  the  blood, 
the  presence  of  alcohol  interferes  with  the 
ordinary  physiological  processes,  with  the  result 
that  certain  of  the  phenomena  that  appear  when 
no  alcohol  is  given  cannot  make  their  appearance 
when  it  is  administered.  In  each  cell  in  our 
body  we  have,  according  to  Ehrhch,^  a  central 
group  of  molecules,  sometimes  a  very  compli- 
cated one,  around  which  are  arranged  a  series  of 
links  or  hooks — receptors,  as  they  are  called. 
To  these  links  or  hooks  other  albuminoid  groups 
are  attached,  and  it  is  through  the  hooking-on 
of  these  albuminoid  groups  that  the  cell  is 
nourished  ;  without  them  it  could  not  link  on 
to  itself  the  material  that  it  requires  for  its 
nutrition.  These  receptors  or  hooks  have  a 
special  affinity  for  other  albuminoid  molecules, 
which,  however,  have  to  be  linked  on  in  a  special 
fashion.  Certain  molecules  acting  as  anchoring 
chains  have  one  form  of  link  at  one  end  and 
another  kind  of  link  at  the  other,  one  form 
holding  to  the  cell,  the  other  attaching  the  mole- 

^  "  Croonian  Lecture,"  Proc.  Roy.  Soc.  Land.,   1900,  vol.  Ixvi. 
p.  424. 


PATHOLOGY  3$ 

cule  to  be  absorbed  ;  without  this  intervening 
and  accommodating  link  the  two  could  never 
be  connected.  This  connecting  chain  is  spoken 
of  as  a  fixative,  and  it  is  a  curious  fact  that  such 
a  kind  of  Hnk  is  always  met  with  in  the  blood. 
It  is  very  stable,  and  is  not  destroyed  by  high 
temperatures.  At  the  outer  end  of  this  fixative, 
and  hooked  on  to  it,  as  it  were,  are  certain 
groups  of  atoms  which  appear  to  be  derived  from 
living  cells.  They  have  certain  characteristics 
similar  to  those  met  with  in  the  '  ferments,' 
and  they  are  destroyed  at  a  temperature  of  from 
50°  to  55°  C.  They  appear  to  play  a  most  im- 
portant part  in  the  nutrition  of  the  cell,  and, 
curiously  enough,  an  equally  important  part  in 
poisoning  them.  These  are  called  complements  or 
alexins. 

"Abbott  and  Bergey  ^  find  that  in  alcoholic 
poisoning  these  complements  are  irregularly  but 
distinctly  reduced,  and  they  maintain  that  this 
reduction  accounts,  first  of  all,  for  the  impaired 
power  of  nutrition  met  with  in  alcoholised 
animals,  on  the  ground  that  there  are  not 
sufficient  complements  to  combine  with  the 
necessary  nutrient  proteid  or  albuminoid 
substances  circulating  in  the  blood.  Moreover, 
the  lack  of  these  complements  is  of  importance, 
from  the  fact  that  without  them  it  appears  to  be 
impossible  for  any  immunity  to  disease  to  be  set 

^  Cenivalbl.  f.  Bakteriol,  u.  Farasitenk,,  Jena,  1902,  i  Abt., 
Originale,  Bd.  xxxii.  S.  260. 


40  MODERN  TREATMENT  OF  ALCOHOLISM 

up  in  an  animaL  They  offer  this  as  an  explana- 
tion of  the  fact  that  in  alcohohsm  impaired 
nutrition  is  first  observed ;  that  this  is  ac- 
companied or  followed  by  an  interference  with 
the  production  of  immunity.  I  have  already 
mentioned  that  the  complement  is  said  to  be 
derived  from  the  white  blood  cells  of  the  body, 
or  from  the  connective-tissue  cells,  or  both,  and 
it  is  evident  that  this  diminution  in  the  amount 
of  the  complement  present  may  be  the  result  of 
diminished  or  markedly  altered  activity  of  the 
leucocytes  and  of  certain  other  cells  of  the  body. 
In  any  case,  the  diminished  amount  of  com- 
plement in  the  blood  should  be  associated  with 
the  diminished  number  of  circulating  leucocytes 
observed  by  Laitinen,  as  an  indication  that  the 
leucocytes  are  not  responding  to  the  calls  that 
have  been  made  upon  them  in  connection  with 
the  nutrition  and  scavenging  of  the  body,  and 
that  they  are  not  assisting  in  the  production  of 
the  immunity  that,  under  the  influence  of  the 
poisonous  substances  that  are  generated  in  the 
body,  should  be  going  on  during  the  course  of 
infective  fevers. 

"  There  can  now  be  httle  doubt  that  alcohol  in- 
terferes with  the  process  of  phagocytosis  ;  more- 
over, both  the  microphages  and  macrophages — 
the  small  cells  and  large  cells  entrusted  with 
the  scavenging  work  of  the  body — are  rendered 
less  active  by  alcohol,  not  only  as  regards  their 
movement,  but  also  as  to  their  power  of  taking 


PATHOLOGY  41 

in  foreign  bodies  and  of  manufacturing  comple- 
ments." 


Alcohol  and  Heat  Loss 

Sir  Lauder  Brunton  has  given  us  an  excellent 
account  of  this  action  of  alcohol  in  his  well-known 
work  The  Action  of  Medicines,  and  I  cannot  do 
better  than  to  quote  it  directly  from  that  source  : 

"  Alcohol  increases  heat  loss. — Now  amongst 
the  drugs  that  are  used  as  antipyretics,  I  may 
mention  one  that  you  might  at  first  hardly  think 
of,  namely,  alcohol.  Alcohol  has  a  double  action 
in  lowering  the  temperature  ;  it  seems  to  lessen 
oxidation,  and  it  dilates  the  vessels  of  the  skin  ; 
and  yet  this  idea  of  alcohol  being  an  antipyretic 
seems  entirely  contrary  to  the  popular  notion 
that  alcohol  warms  you.  The  popular  notion  is 
based  upon  the  feehng  of  warmth  produced  by 
alcohol,  and  the  alcohol  does  warm  a  man  in  one 
way  :  it  warms  his  skin  and  warms  the  ends  of 
the  nerves  in  his  skin,  and  thus  conveys  to  his 
sensorium  the  feeling  of  warmth.  It  is  through 
the  condition  of  the  nerves  of  the  skin  that  we 
judge  of  temperature.  A  man  during  the  cold 
stage  of  an  ague  fit  is  shivering  with  cold  ;  he 
turns  himself  round  and  round  before  the  fire  and 
tries  in  vain  to  get  warm.  Yet  if  you  take  the 
temperature  in  that  man's  mouth  or  in  his 
rectum,  you  will  find  it  is  very  considerably  above 


42  MODERN  TREATMENT  OF  ALCOHOLISM 

the  normaL  He  is  in  a  state  of  pretty  high 
fever,  and  is  far  too  warm  already  inside,  and  yet 
he  is  trying  to  get  warm  because  he  feels  so  cold. 
But  the  cold  he  feels  is  in  the  outside  of  him,  his 
skin  is  cold,  its  vessels  are  spasmodically  con- 
tracted, they  will  not  allow  the  warm  blood  from 
the  interior  of  the  body  to  reach  the  skin,  and 
consequently  the  cutaneous  nerves  are  not 
warm,  and  the  patient  feels  cold.  At  the  end  of 
the  cold  stage  the  vessels  of  the  skin  dilate,  then 
the  warm  blood  from  the  interior  of  the  body 
pours  over  the  surface,  and  the  man  feels  red- 
hot.  Although  he  feels  so  much  hotter  than  in  the 
cold  stage,  he  is  not  really  so.  On  the  contrary, 
he  is  probably  cooler  than  he  was  in  the  cold 
stage  ;  but  he  is  now  conscious  of  the  heat  of 
which  he  was  before  unconscious.  Now  the 
effect  of  alcohol  is  like  that  of  the  change  which 
occurs  in  the  ague  patient  when  the  cold  passes 
into  the  hot  stage.  Alcohol  w^arms  the  skin  at 
the  expense  of  the  internal  organs  b}^  dilating 
the  cutaneous  vessels. 

"In  the  ordinary  healthy  condition  of  a  man, 
when  he  is  exposed  to  cold,  the  vessels  of  the 
skin  contract,  and  the  skin  is  chilly  ;  but  the 
blood,  not  being  allowed  to  circulate  through 
the  skin,  is  kept  warm,  and  so  the  heart, 
the  lungs,  and  the  vital  organs  generally  are 
prevented  from  being  chilled  down.  You  will  find 
on  looking  at  the  records  of  Arctic  observers  that 
they  did  not  like  men  to  drink  alcohol,  and  that. 


PATHOLOGY  43 

as  a  rule,  alcohol  is  prohibited  amongst  men  who 
are  employed  upon  Arctic  expeditions.  But  it 
is  not  only  doctors  or  officers  who  prohibit 
alcohol  under  such  circumstances.  The  men 
themselves  have  become  conscious  that  alcohol 
is  dangerous  when  there  is  great  external  cold, 
and  one  of  the  most  striking  examples  of  this 
that  I  ever  heard  of  was  told  me  by  a  friend  who 
had  been  out  in  Canada.  In  some  of  the  woods 
the  lumber  trade  is  carried  on.  The  men  who 
are  called  *  lumberers  '  live  in  camps  far  away 
from  civilisation.  During  the  whole  winter  they 
fell  the  trees,  and  these  are  simply  dragged  along 
the  snow  to  the  nearest  river,  where  they  are 
made  up  into  rafts.  In  the  early  spring,  when  the 
snow  melts,  they  are  allowed  to  float  down,  and 
the  men  float  down  upon  them.  When  they  get 
to  a  large  town  they  in  a  very  short  time  expend 
the  whole  of  their  winter's  earnings  in  getting 
drunk.  The  moment  they  get  into  the  town  they 
set  to  work  to  get  drunk,  and  they  remain  drunk 
till  they  have  spent  all  their  money.  But  those 
very  men  will  not  have  any  alcohol  near  them 
in  the  winter.  On  one  occasion  a  man  conveyed 
a  cask  of  whisky  into  one  of  their  camps,  and 
the  first  thing  they  did  was  to  take  an  axe  and 
knock  a  hole  in  the  cask,  so  that  the  whole  of 
the  whisky  ran  out.  The  reason  of  this  was, 
they  did  not  dare  to  have  the  whisky  there, 
for  if  it  was  there  they  felt  quite  sure  they  would 
drink  it,  and  if  they  drank  it  they  were  likely 


44  MODERN  TREATMENT  OF  ALCOHOLISM 

to  die.  A  story  of  the  same  sort  was  told  me 
by  the  late  Dr.  Milner  Fothergill.  A  party  of 
engineers  were  surveying  in  the  Sierra  Nevada. 
They  camped  at  a  great  height  above  the  sea- 
level,  where  the  air  was  very  cold,  and  they  were 
miserable .  Some  of  them  drank  a  ht tie  whisky ,  and 
felt  less  uncomfortable  ;  some  of  them  drank  a  lot 
of  whisky,  and  went  to  bed  feeling  very  jolly  and 
comfortable  indeed.  But  in  the  morning  the  men 
who  had  not  taken  any  whisky  got  up  all  right  ; 
those  who  had  taken  a  little  whisky  got  up 
feeling  very  unhappy  ;  the  men  who  had  taken 
a  lot  of  whisky  did  not  get  up  at  all :  they  were 
simply  frozen  to  death.  They  had  warmed  the 
surface  of  their  bodies  at  the  expense  of  their  in- 
ternal organs.  Some  time  ago  Sir  Joseph  Fayrer 
was  out  deer-stalking  in  the  north  of  Scotland. 
He  offered  his  flask  to  the  keeper.  The  keeper  said, 
'  No,  Sir  Joseph,  I  will  not  take  any  to-day  ; 
it  is  too  cold.'  And  yet  if  he  had  drunk  the 
whisky  he  would  have  felt  for  the  time  being  very 
much  warmer  than  before.  So  that  alcohol  tends 
to  act  as  an  antipyretic  by  dilating  the  vessels 
of  the  skin,  and  so  allowing  a  loss  of  heat." 

I  am  able  to  corroborate  the  statements  he 
makes  regarding  the  Canadian  climate,  but 
would  wish  to  point  out  one  fact  in  connection 
with  this,  and  that  is  that  the  statement  regarding 
the  Canadian  woodsmen  in  which  he  refers  to 
their  drinking  up  the  proceeds  of  their  winter's 


PATHOLOGY  45 

work  upon  reaching  the  Settlement  in  the  spring, 
fortunately  no  longer  holds  good  to  the  same 
extent  as  it  did  some  years  ago.  During  the  last 
fifteen  years  a  remarkable  improvement  has 
taken  place  in  the  drinking  habits  of  the  com- 
munity generally,  and  has  proportionately 
affected  the  class  to  which  Sir  Lauder  Brunton 
refers. 

One  cannot  do  better  than  sum  up  the  toxic 
effects  of  alcohol  in  the  following  statement  by 
John  Rose  Bradford  : 

"  The  long-continued  taking  of  alcohol  is 
followed  by  a  great  variety  of  toxic  effects,  some 
temporary  and  others  permanent — some  local 
and  others  general.  As  mentioned  above, 
gastritis  and  dilatation  of  the  stomach  are  apt 
to  occur  as  a  result  of  excessive  drinking.  The 
toxic  effect,  however,  is  not  confined  to  the 
stomach,  but  affects  also  the  liver,  causing  the 
well-known  hepatic  cirrhosis.  Although  this 
disease  is  unquestionably  associated  with  excessive 
drinking,  it  is  not  clear  whether  the  effects  are 
entirely  due  to  alcohol  or  to  other  substances 
present,  inasmuch  as  the  disease  is  not  simply 
correlated  to  the  quantity  of  alcohol  consumed. 
It  may  reach  a  high  development  with  excessive 
beer  drinkers  and  spirit  drinkers  in  some 
countries,  e.g.  England,  whereas  it  is  rarer  in  other 
countries,  as  for  instance  Scotland  and  Ireland. 


46  MODERN  TREATMENT  OF  ALCOHOLISM 

"  Renal  disease,  more  especially  chronic  Bright 's 
disease,  is  also  often  found  associated  with 
alcoholism.  Fatty  degeneration  of  the  heart, 
liver,  and  kidneys  is  not  infrequent ;  a  particular 
variety  of  dilated  heart  is  not  uncommonly  seen 
in  those  addicted  to  alcohol,  especially  in  the 
middle-aged,  the  dilatation  being  deepened  by 
degenerative  changes  in  the  heart  wall.  .  .  . 

"  The  toxic  action  of  alcohol  on  the  nervous 
system  is  very  marked,  producing  delirium 
tremens,  alcoholic  insanity,  and  peripheral 
neuritis.  The  toxic  effects  of  alcohol  are  often 
seen  in  people  addicted  to  taking  it  in  large 
quantities,  although  such  persons  may  never 
suffer  from  acute  intoxication. 

"  Alcoholics,  quite  apart  from  any  definite 
organic  disease,  suffer  from  a  lowered  resistance, 
so  that  they  succumb  readily  to  acute  illnesses 
or  to  accidents.  A  familiar  instance  of  this  is 
the  fatal  course  that  pneumonia  is  likely  to  take 
in  them.  Delirium  tremens  may  be  seen  as  the 
result  of  a  single  debauch,  and  sometimes  it  is 
seen  in  habitual  drinkers  who  are  not  necessarily 
in  the  habit  of  getting  drunk,  and  more  especially 
when  such  persons  fall  victims  to  acute  illness  or 
to  accidents.  It  may  occur  as  a  result  of  stopping 
the  taking  of  alcohol  in  persons  who  are  accus- 
tomed to  large  quantities." 


CHAPTER   III 

THE   CAUSES   OF   INEBRIETY 

Heredity 

Inebriety  considered  as  a  disease  would  be 
influenced  probably  by  heredity  similarly  to 
other  well-known  diseases,  and  this  we  find  to  be 
the  case.  I  do  not  think  the  question  of  heredity 
as  a  cause  of  inebriety  is  denied  by  any  authority 
of  the  present  age.  The  evidence  is  so  over- 
whelming in  support  of  such  a  view,  that  any  one 
attempting  opposition  to  this  theory  would  have 
a  very  difficult,  if  not  impossible,  task.  When 
asking  alcoholic  patients  to  what  they  attribute 
their  drinking  propensities,  how  often  has  one 
heard  the  reply,  "Oh  !  my  father  drank  to  excess," 
or  "  My  parents  drank  to  excess  and  I  inherit 
the  craving"?  Or  else  this  reply,  "There  is 
alcoholism  in  our  family,  and  I  am  a  victim  of 
heredity."  It  is  the  rule  to  find  other  members 
of  the  family  ready  to  corroborate  this  history  of 
inebriety  in  the  patient's  family.    Or  this  question 


48*  MODERN  TREATMENT  OF  ALCOHOLISM 

is  often  asked  by  the  friends  of  the  patient,  "  Do 
you  think,  doctor,  that  there  is  any  chance  of  a 
cure,  for  he  inherits  the  weakness  ?  "  A  large 
number  of  alcohohc  patients  consider  themselves 
incurable  simply  because  they  are  convinced  of 
the  hereditary  nature  of  their  complaint.  Of 
course,  their  belief  in  the  herditary  taint  is  not 
proof  of  its  being  so,  but  one  hardly  ever  gets  a 
history  of  alcoholism  in  which  this  factor  is  not 
more  or  less  prominent  in  some  form  or  other. 

Alcoholism  in  parents  does  not  always  show 
itself  in  the  one  way  in  their  offspring  :  it  may 
break  out  in  one  or  more  members  of  the  family 
as  alcoholism,  or  there  may  be  a  history  of 
alcoholism  in  one  member  and  various  neurotic 
troubles  in  others.  Alcoholism,  neurasthenia, 
hysteria,  chorea,  insanity,  imbecihty,  epilepsy  or 
simple  nervousness  may  be  present,  one  or  all, 
in  the  offspring  of  drinking  parents.  Norman 
Kerr  quotes  two  very  striking  illustrations  of 
this  ;  he  says,  "  In  one  household  with  a  drunken 
father,  two  girls  were  hysterical,  while  a  third  was 
imbecile.  Of  the  sons  the  eldest  was  an  epileptic, 
the  second  boy  died  suddenly  of  alcoholic  apoplexy, 
and  the  third  was  an  idiot."  In  another  family, 
he  says,  **  The  eldest  daughter  committed  suicide, 
the  second  lost  her  reason  and  became  quite 
demented,  and  the  youngest  was  the  incarnation 


THE  CAUSES  OF  INEBRIETY  49 

of  hysteria.  The  elder  son  killed  himself  by 
poison  through  drink,  and  the  younger  is  an 
apparently  confirmed  sot."  Again,  he  says,  "  The 
most  saddening  and  perhaps  the  most  serious 
of  the  numerous  evils  inflicted  by  alcohol  on 
human  kind  is  the  hereditary  transmission  both 
of  the  drink  crave  itself  and  of  the  pathological 
changes  caused  by  indulgence  in  alcohol." 

An  enormous  amount  of  evidence  in  favour  of 
the  hereditary  nature  of  alcoholism  has  been 
contributed  by  writers  on  the  subject,  but  it  is 
manifestly  impossible  to  do  more  in  a  small  work 
like  this  than  to  rapidly  scan  this  field  of  facts. 
My  own  experience  leads  me  to  endorse  this 
view.  The  history  of  alcoholic  heredity  goes 
back  even  to  mythology,  where  we  are  told  that 
Vulcan  lame  was  conceived  by  Jupiter  drunk. 
Diogenes,  addressing  a  stupid  child,  said,  "  Thy 
father  was  drunk  when  thy  mother  conceived 
thee."  Aristotle  said  that  "  a  drunken  mother 
would  produce  drunken  offspring."  The  legis- 
lation of  Lycurgus  promoted  drunkenness  in 
vanquished  nations  in  order  to  destroy  patriotism. 
The  Carthaginian  law  prohibited  any  drink  but 
water  on  the  day  of  cohabitation  with  one's  wife. 
Leaping  across  the  intervening  centuries,  we  find 
the  alienists  of  to-day  unanimous  in  support  of 
this  theory.  Those  who  are  qualified  to  write 
4 


50  MODERN  TREATMENT  OF  ALCOHOLISM 

upon  the  subject  differ  somewhat  regarding  the 
percentage  of  cases  of  alcohoHsm  directly  trace- 
able to  heredity,  but  this  is  not  astonishing,  in 
view  of  the  fact  that  statistics  are  compiled  from 
widely  different  classes  of  patients.  Those  with 
much  experience  in  the  out-patient  department  of 
hospitals  know  how  stupid  such  patients  can 
be  regarding  their  family  history,  and  statistics 
gathered  from  an  institution  containing  only  this 
class  of  patient  would  naturally  vary  greatly 
from  those  compiled  in  one  where  only  a  better 
class  was  received.  Again,  some  may  exclude 
all  evidence  not  directly  alcoholic,  while  others 
will  include  indirect  evidence.  Personally  I 
include  both,  and  consequently  find  the  per- 
centage very  high  ;  in  fact  it  is  difficult  to  avoid 
finding  a  history  of  heredity  if  you  are  dealing 
with  the  educated  classes  and  accept  both  direct 
and  indirect  evidence.  Here  are  the  percentages 
given  by  some  of  those  qualified  to  speak  on  the 
subject  :  Dr.  Dodge  claims  50  per  cent.  ;  Dr. 
Bare  only  25  per  cent.  ;  Dr.  Kerr  over  50  per 
cent.  ;  Dr.  Mognan  claims  over  80  per  cent.  ; 
Dr.  Parrish,  80  per  cent. ;  Dr.  Cr others,  80  per 
cent.  ;  Dr.  Day,  70  per  cent. ;  Dr.  Mason,  60  per 
cent. 

The    transmitted    manifestations    of    alcoholic 
parents  to  their   offspring  are  manifold.     From 


THE  CAUSES  OF  INEBRIETY  51 

the  unstable  brain  to  the  insane  in  the  mental 
system,  from  highly  nervous  to  those  suffering 
from  neurasthenia,  persistent  neuralgias,  chorea, 
hysteria,  etc.,  in  the  nervous  system,  and  from 
slight  departures  from  the  normal  through  all 
sorts  of  deformities,  to  monsters  in  the  physical. 
We  here  quote  the  excellent  conclusions  reached 
by  an  exhaustive  study  of  the  subject  by  Dr. 
Dacaiene  : 

"  I.  Under  the  name  hereditary  alcoholism 
is  included  the  totality  of  the  pathological  mani- 
festations transmitted  to  a  child  by  one  or  either 
of  his  parents  who  are  drinkers,  and  sometimes 
both. 

"2.  The  inheritor  of  this  taint,  as  well  as  the 
drinker  himself,  can  hand  dow^n  not  only  his  own 
vice  but  a  special  morbid  tendency,  a  particular 
neuropathic  state,  which  can  always  be  charged 
to  inebriety. 

"3.  The  alcohohc  inheritance  may  at  first  be 
dormant.  When  it  exists  it  shows  itself  in  infancy 
or  later,  or  in  another  generation.  It  shows 
itself  as  congenital  paralysis,  convulsions,  epilepsy, 
hypochondriasis,  idiocy,  etc. 

"4.  The  increase  in  the  number  of  the  insane, 
of  the  number  of  suicides,  of  crimes  and  mis- 
demeanours— such  are  the  results  of  hereditary 
alcoholism. 

"5.  It  is  in  hereditary  alcoholism  that  can  be 
found  the  explanation  of  certain  monsters  which 


52  MODERN  TREATMENT  OF  ALCOHOLISM 

come  from  time  to  time  to  horrify  society  and 
scandalise  the  courts  of  law. 

"6.  These  degenerate  beings  are  smitten  with 
sexual  impotence.  The  female  inebriate  is  apt  to 
abort,  and  lastly  the  mortality  of  the  newly  born 
among  drinkers  reaches  a  figure  truly  frightful. 

"7.  It  has  often  been  proved  that  in  the  case 
of  drinkers  there  is  a  loss  of  stature  and  physical 
force. 

"  8.  To  sum  up,  hereditary  alcoholism,  as  well 
as  acquired,  determines  an  enfeeblement  of  the 
species,  the  destruction  of  the  family,  and  the 
degeneration  and  abasement  of  the  race. 

"  g.  From  a  medico-legal  point  of  view,  the 
hereditary  inebriate,  in  particular  the  dipso- 
maniac, should  be  regarded  most  of  the  time  as 
irresponsible,  or  at  least  his  responsibility  should 
be  regarded  as  very  limited.  He  is  a  sick  man 
who  should  be  cared  for,  remembering  that  he 
presents  an  undeniable  propensity  to  sickness, 
that  he  possesses  a  defective  intellectual  organisa- 
tion— in  a  word,  that  he  is  a  degenerate.  If  the 
moral  sense  has  not  completely  disappeared,  in 
his  case  at  least  its  use  is  not  accurately  regulated. 
The  judge,  then,  ought  to  take  into  account  this 
moral  state  in  appreciating  his  acts." 


Traumatism  as  a  Cause 

One  frequently  meets  with  cases  of  excessive 
use  of  alcohol  alleged  to  be  due  to  some  injury 


THE  CAUSES  OF  INEBRIETY  53 

to  the  head.  That  these  are  not  merely  **  fairy 
tales "  meant  to  deceive  the  doctor  may  be 
gathered  from  corroborative  scars  and  history 
given  by  friends.  The  history  of  one  case  is 
practically  the  history  of  all  cases  of  this  class, 
and  this  fact  alone  must  go  far  towards  estab- 
lishing the  claim  of  those  who  declare  the  possi- 
bility of  traumatism  as  a  cause  of  inebriety. 

The  history  in  these  cases  is  always  remarkably 
clear  as  to  the  habits  of  the  patient  before  the 
accident,  the  nature  of  the  accident,  and  the 
radical  change  in  the  patient's  habits  subsequent 
to  the  accident.  This  is  only  on  "  all- fours  " 
with  what  surgical  records  abundantly  show  in 
other  directions.  "  He  has  never  been  the  same 
since  the  accident,  doctor,"  is  a  statement  often 
heard  in  hospital  practice.  According  to  the 
nature  of  the  injury  inflicted,  this  may  refer  to 
the  mental,  moral,  or  physical  parts,  one  or  all, 
but  it  is  chiefly  to  injuries  to  the  head  that  a 
change  in  a  patient's  drinking  habits  is  due. 
The  patient  may  have  been  a  total  abstainer  up 
to  the  time  of  receiving  the  injury,  but  he  no 
sooner  resumes  his  usual  avocation  than  a  remark- 
able change  is  noticeable  in  his  drinking  habits. 
He  appears  to  lose  control  over  himself,  and  takes 
to  drinking  like  an  old  toper,  but  with  this 
remarkable  difference — he  is  unable  to  stand  the 


54  MODERN  TREATMENT  OF  ALCOHOLISM 

effect  of  alcohol  so  well,  and  a  much  smaller 
amount  produces  intoxication  than  in  the  more 
seasoned  drinker.  One  of  my  friends  was  a  case 
of  this  kind.  His  history  previous  to  the  accident 
was  that  of  a  man  who,  while  he  was  not  a  total 
abstainer,  was  quite  able  to  take  it  or  leave  it 
alone  at  will.  He  was  taking  a  morning  ride, 
when  his  horse  jibbed,  throwing  him  on  his  head, 
which  was  badly  cut.  Nothing  unusual  was 
noticed  while  he  was  confined  to  his  bed,  but  on 
going  out  he  began  drinking  daily,  and  was 
practically  never  quite  sober  for  over  two  years. 
I  was  able  to  ascertain  that  the  amount  used  each 
twenty-four  hours  did  not  exceed  8  oz.  of  whisky. 
1  had  every  opportunity  of  studying  this  case 
closely,  and  I  am  convinced  that  he  was  absolutely 
unable  to  withstand  the  temptation  to  drink. 
During  this  time  there  was  also  a  great  change  in 
his  personal  habits.  He  became  quite  indifferent 
regarding  his  personal  appearance,  whereas  before 
the  accident  he  was  just  the  opposite.  He  lost 
all  interest  in  his  friends,  abandoned  all  his  usual 
recreations,  took  no  further  interest  in  what  was 
happening  in  the  world,  did  not  even  open  his 
newspapers,  never  attempted  to  read  a  book — in 
fact  his  whole  existence  was  summed  up  in  eating, 
sleeping,  drinking,  and  talking  of  putting  an  end 
to  himself.     He  recovered  entirely  after  about 


THE  CAUSES  OF  INEBRIETY  55 

twenty-eight  months,  and  has  never  taken  or 
desired  to  take  any  intoxicating  beverage  since — 
a  matter  of  nearly  five  years.  After  his  recovery 
he  gradually  resumed  all  his  old-time  interest  in 
himself,  his  friends,  and  the  world  about  him. 
His  memory,  which  he  lost,  has  been  completely 
restored ;  and  to-day,  looking  at  him,  one  would 
not  judge  him  to  have  been  at  one  time  an  appar- 
ently hopeless  drunkard. 

The  majority  of  traumatic  cases  unfortunately 
are  difficult  to  treat,  and  are  often  apparently 
incurable.  The  nature  of  the  injury  received  may 
account  for  this.  If  it  is  one  which  can  be  re- 
moved or  from  which  the  patient  spontaneously 
recovers,  the  desire  to  drink  may  cease,  unless, 
as  sometimes  happens,  a  chronic  inebriety  has 
become  established.  If  the  cause  remains  the 
disease  remains,  and  nothing  appears  to  help  the 
patient  to  a  complete  cure.  In  these  cases  it 
does  not  seem  to  be  an  important  point  whether 
the  patient  was  a  teetotaller  or  not  previous  to 
the  accident,  for  many  of  these  unfortunates 
were  total  abstainers  up  to  that  time. 

Another  class  of  cases  akin  to  these  are  those 
caused  by  sun-stroke  or  heat-stroke.  That  heat- 
stroke has  caused  a  temporary  or  permanent 
mental  change  is  well  known,  and  a  number  of 
inebriates    date    their    alcoholic    excesses    from 


56  MODERN  TREATMENT  OF  ALCOHOLISM 

such  an  attack.  They  resemble  the  traumatic 
cases  in  their  sudden  beginning  and  in  the  small 
amount  of  alcohol  necessary  to  produce  intoxica- 
tion, but  they  differ  in  one  important  point,  namely, 
in  the  effect  of  changes  in  temperature.  The 
man  whose  inebriety  dates  from  a  heat-stroke 
is  always  affected  by  changes  in  temperature 
during  the  warm  season.  This  is  well  illustrated 
in  the  following  history.  A  man  was  sent  to 
the  Norwood  Sanatorium  by  the  superintendent 
of  an  industrial  colony.  As  he  was  a  skilled 
gardener,  I  placed  him  in  charge  of  the  glass 
houses  and  kitchen  garden.  He  was  an  old 
soldier  who  had  served  in  India  and  Egypt  for 
years,  and  his  conduct  while  abroad  was  ex- 
cellent up  to  the  time  of  the  sun-stroke.  His 
attacks  of  inebriety  corresponded  to  some 
unusual  change  in  the  temperature  or  to  a  certain 
phase  of  the  moon  ;  regarding  the  latter  I  was 
inclined  to  be  very  sceptical,  until  repeated 
proofs  left  me  no  other  conclusion.  When  the 
attacks  ended,  he  would  prove  himself  a  hard- 
working, steady  gardener,  ver}^  much  ashamed 
of  his  late  debauch,  and  only  too  anxious  to 
recover  lost  ground.  One  day  it  was  necessary 
for  him  to  spend  hours  in  the  greenhouse  while 
it  was  at  a  high  temperature.  I  called  in  to  see 
how  the  plants  looked,  and  noticed  a  restlessness 


THE  CAUSES  OF  INEBRIETY  57 

about  him  which  indicated  the  probability 
of  an  outbreak.  I  asked  him  if  he  was  not  feeling 
well.  He  replied,  "  Sir,  if  I  stay  in  this  heat 
much  longer  I  shall  go  mad."  I  instantly 
ordered  him  to  attend  to  some  outside  work,  and 
after  an  hour  or  so  in  the  cooler  air  he  regained 
his  usual  composure.  With  this  incident  in  my 
mind  I  was  able  to  trace  some  of  his  outbreaks  to 
prolonged  stay  in  an  overheated  greenhouse. 
Regarding  the  claim  of  this  patient  that  the 
moon  affected  his  drinking  habits,  it  is  curious 
to  note  that  another  patient  of  mine  from  the 
same  colony,  who  was  well  acquainted  with  his 
habits,  told  me  that  the  fact  had  been  well 
noted  there  by  all.  I  state  this  for  what  it  is 
worth.  I  am  not  prepared  to  either  accept  or 
reject  it,  and  will  only  remark,  in  passing  on  to 
the  next  cause,  that  considering  the  powerful 
effect  of  the  moon  on  tides,  one  might  reasonably 
see  a  cause  for  some  effect  upon  circulation, 
especially  in  one  the  equilibrium  of  whose 
circulation  has  been  temporarily  or  permanently 
disturbed.  We  do  know  that  men  who  having 
drunk  alcohol  indoors  without  it  apparently 
affecting  their  sobriety,  immediately  feel  the 
effect  upon  going  out  into  the  cold  air.  This  is 
no  doubt  due  to  the  sudden  chilling  of  the  surface 
of  the  body,  which  by  contracting  the  already 


58  MODERN  TREATMENT  OF  ALCOHOLISM 

distended  superficial  blood  vessels  drives  the 
blood  internally,  and  thus  causes  an  increased 
flow  to  the  brain  ;   hence  the  sudden  intoxication. 


Climate 

Any  attempt  to  describe  the  effect  of  climate 
upon  alcohol  drinking  would  lead  me  into  an 
enormous  amount  of  literature,  but  a  few  of  the 
main  facts  may  not  be  without  interest  to  my 
/  readers.  That  climate  has  an  influence  upon 
the  prevalence  of  inebriety  no  observer  doubts. 
Climate  affects  individuals  in  various  ways, 
hence  the  constant  stream  of  travel  in  search 
of  climatic  conditions  more  suitable  to  the 
travellers'  particular  requirements  ;  and  just  as 
climate  affects  the  health,  so  does  it  affect  the 
conditions  which  make  for  or  against  inebriety. 

The  climatic  conditions  of  Canada  are  par- 
ticularly remarkable  in  this  respect.  In  the 
vast  North-West  of  that  country  electrical  con- 
ditions play  an  important  role.  Even  in  Ontario 
the  air  is  dry  and  highly  charged  with  electricity. 
I  have  seen  a  boy  while  pulling  off  his  woollen 
vest  in  a  dim  light  produce  a  perfect  shower  of 
electric  sparks,  this  being  accompanied  by  a 
loud  crackling  noise.  A  lady  combing  out  her 
hair    with    a    vulcanite    comb    often    produces 


THE  CAUSES  OF  INEBRIETY  59 

electrical  phenomena  which  would  prove  very 
startling  to  those  who  only  know  our  English 
climate.  I  was  once  present  at  a  family  gather- 
ing in  Toronto  when  some  one  suggested  light- 
ing the  gas  with  their  fingers.  I  suspected  some 
joke,  but  not  only  was  it  done,  but  I  found  by 
following  a  few  simple  directions  I  could  do  it 
myself.  All  I  had  to  do  was  to  shuffle  my  feet 
across  the  carpet  for  a  minute,  and  then  with  a 
poker  in  hand  present  the  end  to  the  turned-on 
gas  jet,  when  a  discharge  of  electricity  producing 
a  spark  an  inch  long  leapt  across  from  my  body 
through  the  poker  to  the  metal  gas  pendant, 
igniting  the  gas.  Some  persons  were  able  to 
light  the  gas  by  merely  snapping  their  fingers. 
Two  junior  members  of  the  family  amused  them- 
selves by  shuffling  their  feet  across  the  carpet, 
and  then  approaching  some  member  of  the 
gathering  unseen  would  give  them  a  sharp  shock 
by  merely  presenting  one  finger  to  any  part  of 
their  body.  They  were  practically  Leyden  jars 
or  condensers,  and  they  charged  and  discharged 
themselves  in  this  manner.  Another  striking 
instance  of  the  electrical  conditions  of  North 
America  is  illustrated  in  the  following  incident. 
A  friend  of  mine,  an  electrician,  left  Toronto, 
where  the  above  conditions  existed,  to  take  up 
an  important  management  in  one  of  the  North- 


6o     MODERN  TREATMENT  OF  ALCOHOLISM 

Western  States.  He  told  me  how  delighted  and 
fortunate  he  was  to  obtain  the  post.  I  met  him  a 
few  weeks  after  in  Toronto.  He  explained  his 
return  by  stating  that  the  electrical  conditions 
there  were  so  intense  as  to  make  work  impossible. 
He  could  neither  rest  nor  sleep,  and  was  forced 
to  resign  his  position  owing  to  these  conditions. 

Now  this  highly  charged  climate  has  a  peculiar 
effect  upon  drinking.  The  need  of  a  stimulant 
is  not  felt,  as  the  air  is  a  natural  stimulant,  and 
if  one  accustomed  to  alcohol  in  England  goes  to 
the  North-West  and  attempts  to  continue  his 
English  habits  of  beer  or  spirit  drinking,  he 
generally  comes  to  a  rapid  end  in  an  attack 
of  D.T.'s.  The  "remittance  men"  who  were 
sent  out  to  North- West  Canada  often  died  through 
the  effect  of  drink  plus  climate.  It  was  poor 
policy  on  the  part  of  parents  or  guardians  to 
land  them  in  such  a  climate  with  perhaps  a 
weakness  for  drink  and  no  occupation.  It 
meant  the  end. 

That  alcohol  is  a  dangerous  drink  in  cold 
climates  is  well  illustrated  in  the  following  incident, 
of  which  I  was  an  eye-witness.  A  farmer  was 
bringing  a  load  of  hay  to  Toronto  to  sell.  The 
weather  was  very  cold,  being  some  degrees  below 
zero,  and  instead  of  walking  to  warm  himself,  he 
entered  an  inn  and  had  a  glass  of  hot  whisky  and 


THE  CAUSES  OF  INEBRIETY  6i 

water,  and  then,  climbing  back  upon  his  load, 
resumed  his  journey.  The  horses  apparently 
knew  their  way  well,  for  they  brought  the  hay 
safely  into  the  Market  Square  and  then  stopped, 
with  the  owner  sitting  on  the  top  of  the  load 
still  holding  the  reins  in  his  hands.  He  was 
dead,  and  had  been  so  for  some  time — frozen 
stiff.  What  happened  was  simply  this ;  the 
alcohol  he  took  dilated  the  superficial  vessels  of 
the  body,  permitting  an  enormous  escape  of 
heat,  and  he  began  to  freeze  in  consequence. 
Now  it  is  a  well-known  fact  that  in  the  process  of 
freezing  to  death  a  great  drowsiness  comes  on, 
and  unless  the  victim  is  aroused  in  time  he  dies 
while  asleep.  Sitting  on  top  of  his  load,  he 
no  doubt  dozed  into  eternity.  Alcohol  is  a 
deadly  drink  in  very  cold  climates,  that  is  why 
it  is  prohibited  in  all  Polar  expeditions.  It  is  a 
great  mistake  for  drinkers  to  think  that  alcohol 
warms  them,  for  the  opposite  is  the  case.  What 
happens  is  this  ;  the  small  blood  vessels  of  the 
surface  of  the  body  are  dilated  by  the  alcohol, 
and  produce  a  sensation  of  warmth  in  the  sensory 
nerve  ends  of  the  skin.  The  impression  received 
by  the  brain  is  the  same  as  that  produced  when 
a  chilly  person  closely  approaches  a  good  fire. 
This  sensation  of  warmth  is  apparent  long  before 
it   is   possible   for   the   body   heat   to  be  raised 


62  MODERN  TREATMENT  OF  ALCOHOLISM 

appreciably.  In  the  case  of  the  farmer  mentioned 
above,  if,  at  the  time  when  he  was  apparently 
feeling  warmer  for  the  drink  he  had  taken,  a 
clinical  thermometer  had  been  placed  under 
his  tongue,  it  would  have  shown  a  fall  instead 
of  a  rise  in  temperature. 

In  cold  countries  the  great  majority  of  deaths 
by  freezing  are  due  to  alcohol.  The  Canadian 
knows  this,  and  avoids  it.  In  the  great  lumber- 
ing camps  in  that  country  no  alcohol  whatever  is 
allowed ;  and  indeed  it  is  recorded  that  on  one 
occasion  when  a  visitor  brought  a  case  of  spirits 
into  the  camp,  the  men  rushed  upon  it  and 
destroyed  it  with  their  axes,  spilling  the  whisky 
upon  the  snow.  These  same  men  who  w^ould 
not  allow  a  drop  of  spirits  in  the  camp  would  go 
into  the  towns  in  spring  and  drink  up  all  their 
winter's  earnings  in  a  few  weeks'  time.  Regard- 
ing Canada  generally,  I  may  say  that  the  climate 
being  so  invigorating  there  is  comparatively 
little  drinking  done,  and  that  mostly  by  new- 
comers from  this  side.  An  Englishman,  a  friend 
of  mine,  was  staying  at  the  Queen's  Hotel,  Toronto, 
and  ordered  a  small  Bass  for  his  lunch.  During 
the  meal  he  looked  about  the  large  dining-room 
to  note  what  the  other  guests  were  drinking, 
and  to  his  surprise  he  found  he  was  the  only  one 
drinking   an   alcoholic   beverage.     After    two   or 


THE  CAUSES  OF  INEBRIETY  63 

three  days  of  a  similar  experience,  he  ceased  to 
order  his  Bass,  because  it  made  him  conspicuous. 
I  have  had  many  meals  in  Canadian  hotels,  and 
my  friend's  experience  exactly  corroborates  my 
own.  While  speaking  of  the  effect  of  climate  in 
Canada  upon  drinking  habits,  I  may  add  another 
experience  occurring  during  a  visit  there  four 
years  ago.  I  stayed  with  many  friends  from 
Montreal  to  Chicago,  my  visit  covering  a  period 
of  nearly  three  months,  and  during  that  w4iole 
time  I  was  never  offered  or  saw  any  alcoholic 
beverage  except  in  one  house,  and  that  was  a 
half-bottle  of  whisky  kept  solely  for  medicinal 
purposes,  and  which  was  only  brought  out  on 
account  of  a  sudden  illness.  These  were  all 
people  of  a  well-to-do  class,  and  the  very  soul 
of  hospitality,  yet  it  never  occurred  to  them  to 
keep  or  offer  spirits  to  their  guests.  If  a  man 
does  attempt  to  drink  in  Canada  as  he  did  before 
leaving  Engand,  it  generally  leads  to  his  down- 
fall ;  the  moderate  drinker  here  becomes  an 
excessive  one   there. 

Some  people  cannot  go  for  an  ocean  trip  with- 
out drinking  to  excess  while  on  board,  but  one 
cannot  safely  attribute  this  to  change  of  air, 
although  I  have  shown  above  that  change  of  air 
of  a  certain  character  does  produce  inebriety, 
for  there  are  several  factors  at  work  aboard  ship, 


64  MODERN  TREATMENT  OF  ALCOHOLISM 

and  while  the  change  of  cUmatic  conditions 
may  be  responsible  for  some  cases  at  sea,  the 
most  powerful  factor  to  my  mind  in  many  cases 
is  the  sudden  withdrawal  of  the  restraining 
environment  of  home  influences  and  the  rebound 
which  naturally  results.  Once  while  crossing 
from  New  York  to  Liverpool,  we  had  as  a  fellow- 
passenger  a  most  gifted  Presbyterian  minister. 
Day  after  day  this  man  became  incapably  drunk, 
and  those  frequenting  the  smoking-room  were 
treated  to  the  painful  spectacle  of  his  being 
carried  off  to  bed  by  his  wife  nightly.  She  would 
enter  the  room,  throw  her  strong  arms  about 
him,  and,  refusing  all  help,  march  off  with  her 
burden,  casting  indignant  glances  at  those  re- 
maining. I  am  quite  convinced  she  blamed  the 
occupants  of  the  smoking-room  for  his  excesses. 
In  that  she  w^as  wrong,  for  it  was  an  understood 
thing  among  the  frequenters  of  the  room  that 
no  one  ought  to  accept  his  invitation  to  join 
him  in  his  indulgences.  The  sudden  withdrawal 
of  all  the  restraining  influences  of  his  parish  to 
the  opposite  condition  found  in  the  smoking- 
room  must  have  been  an  important  factor  at 
least.  I  have  seen  many  instances  of  this  ex- 
cessive drinking  at  sea,  and  on  inquiry  have  been 
able  in  a  large  majority  of  cases  to  ascertain  that 
the  outbreak  was  quite  contrary  to  their  usual 


THE  CAUSES  OF  INEBRIETY  65 

habits  at  home.  Sea -trips  affect  different 
people  in  different  ways.  They  exhilarate  and 
tone  some,  while  they  depress  others,  and  I  think 
there  can  be  no  doubt  that  they  disturb  the 
nervous  balance  in  most  travellers.  This  dis- 
turbance may  be  just  sufficient  to  unbalance  the 
will-power  of  the  individual.  It  must  not  be 
thought  from  the  above  remarks  that  I  consider 
sea-trips  unsuitable  for  inebriates.  Under  proper 
conditions  and  control  the  tonic  effect  of  sea  air 
may  do  much  good  in  restoring  the  lost  nerve 
tone,  but  the  indiscriminate  sending  to  sea  of 
inebriates  without  proper  control,  in  the  hope  of 
benefit,  is  to  be  strongly  deprecated. 

Disease  as  a  Cause  of  Inebriety 

There  are  many  diseases  which,  directly  or 
indirectly,  may  be  said  to  cause  alcoholism.  In 
a  sound,  healthy  organisation  alcoholism  is  im- 
possible. There  must  be  a  weakened  condition 
of  some  portion  of  the  system  before  the  disease 
of  inebriety  can  affect  its  victim.  In  a  large 
majority  of  cases  these  conditions  are  so  evident 
as  to  be  unmistakable  even  to  the  eye  of  the 
laity.  In  others  they  are  less  marked  but  yet 
readily  recognised  by  the  attending  physician, 
while  in  a  small  minority  they  are  obscure.  The 
5 


66  MODERN  TREATMENT  OF  ALCOHOLISM 

list  of  diseases  causing  alcoholism  is  a  very  long 
one,  and  reference  can  be  made  here  to  only  a  few 
of  the  more  general  ones. 


Heart  Disease  as  a  Cause  of  Inebriety 

Many  cases  of  alcoholism  are  caused  by  heart 
disease.  The  majority  of  these  patients  are 
women  who  have  at  some  period  of  their  cardiac 
trouble  been  directed  by  their  doctor  to  take  a 
little  stimulant  to  relieve  their  distress.  The 
intention  of  the  physician  may  have  been  innocent 
enough,  but  I  cannot  help  feehng  very  strongly 
about  the  almost  criminal  carelessness  of  such 
prescribing,  when  the  victims  present  themselves 
for  treatment.  It  is  not  so  much  a  question  of 
what  is  prescribed  as  of  how  it  is  prescribed. 
When  we  consider  how  completely  our  patients 
rely  upon  our  advice  and  how  confidently  they 
carry  it  out  because  it  is  our  advice,  and  how 
much  more  likely  this  is  to  be  done  if  the  following 
of  our  directions  is  pleasant  to  them  at  the  same 
time,  and  when  one  considers  what  terrible  results 
often  follow  the  advice  given,  I  think  I  am  justi- 
fied in  saying  that  the  prescribing  of  alcohol 
is  one  of  the  most  responsible  acts  of  a  doctor's 
life ;  and  yet,  as  we  all  know,  many  medical  men 
who  would  carefully  watch  the  exact  dose  and 


THE  CAUSES  OF  INEBRIETY  67 

effect  of  morphia  or  arsenic  upon  a  patient,  light- 
heartedly  and  carelessly  tell  their  cardiac  patient 
to  take  a  little  stimulant  when  the  distressing 
symptoms  return.  I  have  emphasised  this  point, 
because  I  believe  that  many  of  those  careless 
prescribers  of  alcohol  never  have  an  opportunity 
of  seeing  the  results  of  their  carelessness,  or,  if 
they  do  see  it,  it  is  in  circumstances  which  do  not 
connect  the  cause  with  the  result  in  their  mind. 
If  it  is  desired  to  prescribe  alcohol  it  ought  to  be 
done  in  the  safest  manner  possible.  In  cases  of 
heart  disease  the  quantity  is  not  large,  and  can 
be  readily  prescribed  in  the  form  of  pure  CoHgO  in 
some  disguise  or  other.  The  respect  of  a  patient 
for  a  bottle  of  medicine  will  in  all  probability 
prevent  him  from  taking  more  than  the  ordered 
dose,  whereas  if  he  knows  it  to  be  alcohol,  his 
limitation  is  fixed  not  by  the  doctor's  orders 
but  by  his  desire  and  access.  If  he  is  reproved 
for  taking  it  by  his  friends,  he  lightly  says,  "  Oh  ! 
my  doctor  ordered  it,"  which  to  his  mind  settles 
the  question.  In  regard  to  these  heart  cases 
one  can  readily  see  why  they  are  so  prolific  of 
alcoholism,  when  one  thinks  of  the  fear  of  im- 
pending death  which  the  patient  experiences  and 
the  rapid  relief  felt  on  taking  the  stimulant. 

I  do  not  here  purpose  dealing  with  the  value 
or   otherwise   of   prescribing   alcohol   in   cardiac 


68  MODERN  TREATMENT  OF  ALCOHOLISM 

cases,  but  I  would  earnestly  entreat  those  of  the 
profession  who  prescribe  it  to  disguise  the  real 
nature  of  the  remedy.  If  this  were  done  in  every 
case,  I  am  convinced  there  would  soon  be  a  con- 
siderably lessened  proportion  of  alcoholic  women. 
Surely  that  is  worth  a  little  extra  trouble.  In 
the  beginning  the  women's  first  care  is  to  get 
relief ;  she  is  not  yet  an  alcoholic,  and  so  long 
as  she  has  measrued  doses  of  medicine  by  her 
which  give  her  that  relief  she  is  content ;  but  let 
her  once  learn  that  it  is  alcohol  she  is  relying 
upon  and  she  is  undone.  She  at  once  feels  free  to 
use  it  in  larger  doses  and  at  all  times,  and,  her 
resisting  power  being  already  greatly  decreased 
by  her  physical  ailment,  she  readily  becomes  a 
confirmed  alcoholic.  I  have  had  many  such 
patients  under  my  care,  and  in  every  case  they 
asked  the  same  question,  *'  What  am  I  to  do  if  I 
cannot  take  brandy  when  I  feel  faint  ?  "  If  they 
had  always  had  a  properly  disguised  dose  by  them 
there  would  have  been  no  need  for  the  question, 
and  in  very  many  cases  no  excess. 

Indigestion  as  a  Cause  of  Inebriety 

Functional  heart  cases  are  just  as  prolific 
sources  of  alcoholism  as  organic  heart  cases. 
The  symptoms  of  distressed  feeling  are  far  more 


THE  CAUSES  OF  INEBRIETY  69 

severe  in  these  than  in  organic  trouble  in  the 
early  stages,  and  consequently  more  liable  to 
create  alcoholism.  They  are  secondary  in  char- 
acter, and  the  most  common  exciting  cause  is 
gastric  disturbance.  When  the  stomach  is  over- 
loaded either  by  food  or  gas,  it  incommodes  the 
heart,  which  practically  rests  upon  it  with  only 
the  diaphragm  separating  them.  The  distended 
stomach  not  only  incommodes  the  heart,  it  also 
irritates  it,  and  then  the  patient  feels  a  sudden 
alarming  sensation  as  if  he  were  going  to  die. 
Now,  in  the  case  of  the  distension  being  due  to  an 
accumulation  of  gas,  an  immediate  relief  is  ex- 
perienced when  the  gas  is  belched  up,  and  any- 
thing which  will  do  this  is  eagerly  taken  by  the 
patient.  Unfortunately  for  him  it  is  generally 
alcoholic  stimulants  which  are  most  frequently 
at  hand,  and,  having  once  experienced  the  relief 
obtained  from  their  use,  he  continues  to  rely  upon 
them  to  his  ultimate  destruction.  There  are 
numerous  innocent  antispasmodics  which  will 
relax  the  cardiac  orifice  of  the  stomach  and  permit 
the  gas  to  escape  just  as  well  as  alcohol  will.  I 
was  much  struck  with  what  occurred  to  a  lady 
patient  of  mine  some  years  ago  while  eating  her 
dinner.  She  was  apparently  in  her  usual  health, 
and  was  laughing  and  talking  at  the  time.  Sud- 
denly with  a  look  of  horror  and  fear  upon  her  face 


70  MODERN  TREATMENT  OF  ALCOHOLISM 

she  attempted  to  stand,  clutching  wildly  with 
both  hands  at  her  throat  ;  then  instantly  pressing 
them  against  her  heart  and  with  staring  eyes  and 
livid  complexion,  moaning  that  she  was  dying. 
The  picture  was  startling  enough  even  to  a  medical 
man,  coming  so  suddenly  in  the  midst  of  a  pleasant 
dinner-party,  yet  such  a  simple  remedy  as  a 
teaspoonful  of  bi-carbonate  of  soda  stirred  into  a 
glass  of  hot  water  was  sufficient  to  produce 
immediate  relief — by  relaxing  the  tension  of  the 
stomach  and  consequently  relieving  the  irritation 
of  the  cardiac  organ.  In  a  few  minutes  with  the 
exception  of  the  shaken  nerves  the  patient  was  as 
well  as  before  the  attack.  Nothing  astonished 
the  patient  more  than  the  fact  of  such  a  simple 
remedy  being  so  efficacious.  I  well  remember 
her  saying  afterwards,  "  Here  I  have  been  drink- 
ing brandy  for  years  under  the  impression  that 
nothing  else  would  save  my  life  !  "  We  all  know 
how  readily  alcohol  produces  indigestion.  First 
the  congestion,  then  the  inflammation,  then  the 
chronic  gastritis  with  excess  of  mucus  and 
deficiency  of  gastric  juice,  producing  a  long  train 
of  distressing  symptoms  ;  it  thus  comes  about 
that  those  who  resort  to  alcohol  to  relieve  their 
stomach  trouble  only  succeed  in  increasing  it 
later  on.  I  here  quote  an  instance  of  indigestion 
as  a  cause  of  alcoholism.     I  do  so  fully  because  I 


THE  CAUSES  OF  INEBRIETY  71 

have  found  many  patients  in  whom  indigestion 
was  the  starting-point  of  their  drunkenness,  and 
the  story  may  help  to  fasten  the  principle  in  the 
mind.  A  young  married  man,  aged  about  thirty, 
a  farmer,  came  for  treatment  for  alcohoHsm  some 
fifteen  years  ago.  At  this  particular  date  my 
sanatorium  was  overcrowded,  and  I  turned  a 
large  room  in  my  own  residence  near  by  into  a 
dormitory,  and  in  this  room  the  patient  was 
given  a  bed.  His  progress  was  very  similar  to 
that  of  the  other  patients  for  the  first  four  weeks, 
which  means  that  at  the  end  of  the  first  two  or 
three  days  he  asked  for  no  more  whisky,  or  felt 
the  desire  for  any,  while  he  rapidly  improved  in 
every  direction  during  the  next  three  or  four 
weeks — eating,  sleeping,  and  feeling  extremely 
well.  Then  a  number  of  the  patients  attended  an 
entertainment  in  the  village,  and  he  accompanied 
them.  It  was  noticed  that  he  seemed  dull  and 
out  of  sorts,  while  the  others  were  laughing  heartily 
at  the  jokes  from  the  stage.  About  midnight  the 
patients  sharing  his  room  were  awakened  by  his 
uncontrollable  sobbing,  the  cause  of  which  he 
refused  to  state.  Next  morning,  feeling  ashamed 
of  having  disturbed  their  rest,  he  told  them  the 
reason.  He  said,  "All  you  men  are  going  home 
cured,  while  I  must  return  to  my  wife  and  chil- 
dren still  cursed  with  the  craving  for  drink,  after 


72  MODERN  TREATMENT  OF  ALCOHOLISM 

I  thought  I  was  cured,  and  it  was  this  knowledge 
which  broke  me  down  last  night.  I  did  not  know 
how  I  was  to  face  my  wife  after  sending  her  such 
hopeful  letters.  I  thought  I  was  completely 
cured,  and  now  I  must  go  back  to  the  same  old 
life,  and  I  am  afraid  it  will  break  her  heart."  On 
being  asked  why  he  thought  he  was  not  cured,  he 
replied,  "  Last  night  the  old  craving  came  back  as 
strongly  as  ever,  and  if  I  had  not  been  with  you 
all  at  the  theatre  I  would  have  gone  and  had  a 
drink."  He  was  advised  to  see  me  at  once,  which 
he  did.  After  listening  to  his  story,  I  asked  him 
to  describe  the  form  the  craving  took.  He  said 
it  was  a  peculiar  sensation  in  the  stomach,  and 
had  always  been  the  beginning  of  his  drinking 
bouts.  Remembering  this  man's  unusually 
hearty  appetite  at  table,  and  also  his  disinclina- 
tion for  exercise,  I  examined  his  tongue  and  found 
it  heavily  coated.  I  then  ascertained  from  him 
that  the  so-called  craving  had  an  earlier  history 
than  that  of  the  alcoholism,  and  he  admitted  that 
he  used  to  take  the  whisky  at  first  to  relieve  this 
peculiar  sensation  in  the  stomach.  The  whole 
secret  was  now  out  :  first  the  indigestion,  then  a 
glass  of  whisky  to  relieve  it,  then  the  intemper- 
ance, and  finally  the  belief  that  the  sensation  was 
a  craving  because  it  was  the  starting-point  of 
every  outbreak  of  drinking.     I  told  him  to  cease 


THE  CAUSES  OF  INEBRIETY  73 

worrying,  as  he  was  quite  mistaken  about  it  being 
a  craving  ;  it  was  only  indigestion  due  to  over- 
feeding, and  insufficient  exercise,  and  that  in 
twenty-four  hours  it  would  vanish  without  any 
alcohol  whatever.  A  blue  pill  that  night, 
followed  by  a  Seidhtz  the  next  morning  com- 
pletely removed  the  so-called  craving.  He  was 
very  grateful  and  happy  when  he  learned  that  the 
pain  was  not  a  craving  for  alcohol,  and  determined 
to  avoid  a  recurrence  of  it  in  future  by  regulating 
his  diet  and  taking  more  exercise.  I  heard  from 
his  wife  years  afterwards,  and  she  assured  me  that 
her  husband  never  tasted  or  allowed  in  his  home 
any  stimulants,  and  was  quite  a  different  man 
from  what  he  had  been  for  years  before  his  treat- 
ment. If  I  have  dwelt  somewhat  at  length  upon 
this  case,  it  is  because  it  represents  a  large  class  of 
patients,  and  shows  clearly  that  indigestion  does 
cause  inebriety.  But  a  still  more  important 
point  is  this — what  would  have  happened  if  his 
indigestion  had  not  occurred  until  he  had  returned 
home  ?  It  would  have  changed  his  whole  life, 
as  he  would  have  relapsed  at  once,  lost  all  hope, 
and  gone  completely  to  the  dogs.  It  is  most 
important  to  warn  these  patients  before  leaving 
the  sanatorium  of  what  may  happen.  Another 
patient  had  a  similar  experience,  the  fancied 
craving  coming  on  at  the  station  while  he  was 


74  MODERN  TREATMENT  OF  ALCOHOLISM 

waiting  for  his  train  in  order  to  return  home.  He 
wisely  decided  to  leave  by  a  later  train  and 
return  to  the  sanatorium  to  consult  me.  I 
found  the  same  cause  at  work,  relieved  his  fears, 
and  had  the  satisfaction  of  treating  several  friends 
subsequently  recommended  by  him,  and  of 
meeting  him  for  years  only  to  find  him  more 
grateful  each  time  for  the  cure  effected.  An  inn 
stood  opposite  the  station,  and  he  told  me  after- 
wards that  when  he  thought  the  craving  had 
returned  he  became  so  hopeless  and  depressed 
that  he  debated  with  himself  for  some  minutes 
as  to  whether  he  would  go  over  and  start  drink- 
ing or  would  return  and  see  me.  Surely  his  good 
angel  must  have  been  very  near  him  at  the  time. 
When  we  consider  the  various  forms  which 
indigestion  assumes,  one  cannot  help  wondering 
how  large  a  proportion  of  alcoholic  cases  have 
their  origin  in  gastric  ailments. 

Neurasthenia  as  a  Cause  of  Inebriety 

Men  indulge  in  alcoholic  stimulants  from  three 
main  motives,  namely,  from  a  desire  to  be  sociable, 
in  order  to  relieve  some  temporary  ailment  or 
discomfort,  and  to  satisfy  a  craving  for  the  stimu- 
lant. There  are  many  subdivisions,  but  if  we 
accept   these   three   main    motives   we   will   hnd 


THE  CAUSES  OF  INEBRIETY  75 

the  second  one  very  prolific  of  causes  of  in- 
ebriety, and  one  of  the  most  potent  of  these  is 
neurasthenia.  The  term  neurasthenia  means 
nerve  exhaustion.  Some  authors  would  divide 
the  disease  into  a  long  list  of  subdivisions  accord- 
ing to  the  peculiar  form  the  symptoms  assume, 
while  others  content  themselves  with  the  simple 
term  neurasthenia,  classing  all  the  symptoms 
under  it.  In  either  case,  the  main  point  for  the 
student  of  inebriety  is  the  almost  endless  list  of 
symptoms  belonging  to  this  disease,  and  their 
reaction  upon  the  mind  of  the  patient.  For 
the  benefit  of  the  lay  reader  of  this  little  work, 
it  may  be  as  well  to  enumerate  a  few  of  the 
leading  symptoms  of  neurasthenia.  Some  of 
these  patients  are  very  easily  fatigued,  fatigued 
beyond  all  comparison  to  the  exercise  taken,  and 
have  a  strong  disinclination  for  exertion  of  any 
kind.  This  may  be  so  marked  as  to  cause  the 
sufferer  to  feel  annoyed  having  to  make  the 
exertion  sufficient  to  write  out  a  receipt  for  money 
paid  him,  although  his  financial  position  may  be 
such  as  to  make  this  payment  a  veritable  god- 
send to  him.  Coupled  with  this  aversion  to 
exertion,  there  is  often  an  incessant  restlessness 
which  is  accentuated  by  mere  restraint  of  it. 
One  of  my  patients  was  a  typical  example  of 
this   form.     He   wore   away   the   carpet  beneath 


76  MODERN  TREATMENT  OF  ALCOHOLISM 

his  chair  by  this  incessant  movement,  and  this 
became  so  marked  at  meal-times  as  to  compel 
him  to  leave  the  table  long  before  he  had  finished 
his  meal ;  yet  it  was  next  to  impossible  to  get 
him  to  take  a  short  walk  in  the  grounds.  The 
same  patient  was  a  good  lawn-tennis  player,  and 
under  this  stimulus  his  symptoms  fell  from  him 
like  the  dropping  of  a  cloak,  and  to  watch  his 
alert  movements,  his  keen  interest  and  entire 
absence  of  fatigue  during  a  tennis  tournament, 
one  could  hardly  credit  him  with  anything  but 
perfect  health.  Another  peculiarity  was  his 
strong  aversion  to  entering  a  cab  or  train  or  even 
to  cross  a  quiet  street  without  the  greatest  fear 
of  some  impending  disaster.  In  others,  concen- 
tration of  mind  is  impossible  even  for  a  very 
short  time,  and  if  given  a  simple  mental  problem 
to  solve  will  become  hopelessly  confused  at  once, 
with  a  resulting  irritation  at  not  being  able  to 
control  this  condition.  Others  again  enthusi- 
astically plunge  into  some  work  or  scheme  only 
to  throw  it  up  in  disgust  shortly  afterwards — as 
soon  as  the  stimulus  of  novelty  has  ceased  to 
act.  I  had  many  opportunities  of  witnessing 
this  form.  Attached  to  my  Norwood  Sana- 
torium were  beautiful  and  interesting  grounds, 
and  on  a  fine  spring  morning  I  have  seen  a 
number  of  patients  plan  to  do  some  garden  work. 


THE  CAUSES  OF  INEBRIETY  77 

The  neurasthenics  were  the  most  enthusiastic 
of  all,  but  after  half  an  hour  or  so  the  only  workers 
were  those  in  whom  the  neurasthenic  symptoms 
were  least  marked.  Another  class  of  neuras- 
thenics are  morbidly  minded.  They  are  quite 
convinced  that  they  are  the  victims  of  this  or 
that  disease,  and  yet  no  organic  trouble  can 
be  detected  by  the  most  careful  examination. 
You  no  sooner  convince  them  of  the  absence 
of  one  disease  than  they  are  convinced  that  it  is 
another  form  from  which  they  suffer.  Others 
again  suffer  from  vague  pains  in  the  head,  body, 
or  limbs.  To  the  patients  themselves  these 
symptoms  and  pains  are  as  real  as  if  they  existed. 
It  is  useless  to  deny  their  existence  to  the  patients, 
because  they  cannot  accept  your  bare  word  as 
against  their  experience.  At  the  same  time  it 
is  necessary  to  discourage  them  in  their  belief. 
How  real  these  symptoms  are  to  the  sufferer 
only  those  who  have  experienced  them  know. 
To  illustrate  this,  I  may  be  permitted  to  add  my 
personal  testimony.  For  a  period  of  from  two 
to  three  years  I  was  under  a  severe  strain  which 
culminated  in  an  attack  of  nerve  exhaustion, 
during  which  I  suffered  many  of  the  above 
symptoms,  and  was  finally  compelled  to  take  a 
three  months'  holiday,  including  an  ocean  trip. 
I  returned  hoping  I  was  cured,  but  the  hohday 


78  MODERN  TREATMENT  OF  ALCOHOLISM 

was  not  long  enough  or  had  not  the  elements  of 
cure  in  it,  for  I  soon  relapsed  into  the  old  con- 
dition. The  struggle  to  do  my  duty  under  such 
conditions  was  heartbreaking,  and  finally  I  had 
to  dispose  of  my  sanatorium  to  its  present  owners 
and  set  about  curing  myself.  Since  recovering 
my  health  I  find  a  fuller  and  deeper  sympathy 
with  those  afflicted  with  the  same  disease. 

I  have  dwelt  upon  this  disease  somewhat  at 
length,  because  I  know  that  many  of  these  cases 
are  cruelly  treated  by  their  friends  through 
ignorance  of  the  subject ;  and  if  readers  of  the 
above  are  in  touch  with  such  unfortunates,  it  may 
tend  to  lessen  their  contempt  at  their  suffering 
and  stimulate  a  desire  to  give  them  proper  treat- 
ment. 

One  has  only  to  look  at  the  list  of  the  sufferings 
of  neurasthenics  to  realise  how  strongly  alcohol 
would  appeal  to  them  as  a  temporary  relief,  and 
then  if  one  adds  to  this  the  fact  that  it  is  in  just 
such  a  condition  of  the  nerves  when  alcohol 
acts  most  energetically,  one  can  easily  see  how 
it  is  that  these  sufferers  fall  such  easy  victims 
to  alcoholism.  For  years  I  was  convinced  that 
all  alcoholics  were  neurasthenics,  and  although 
I  have  modified  this  opinion  somewhat,  it  still 
holds  good  for  a  large  majority  of  cases.  The 
instabiUty  of  their  nerve  force  induces  the  taking 


THE  CAUSES  OF  INEBRIETY  79 

of  alcohol  which  in  turn  increases  the  instability, 
this  leading  to  excessive  use  of  the  stimulant 
with  increased  disturbance,  and  thus  the  vicious 
circle  goes  on,  to  the  complete  undoing  of  the 
victim. 

General  Debility  as  a  Cause  of 
Inebriety 

Any  lowering  of  the  vital  forces  may  lead  to 
alcoholism.  For  instance,  a  medical  man  is 
temporarily  overworked  and  deprived  of  sufficient 
rest.  He  knows  perfectly  well  what  he  ought 
to  do,  but  for  various  reasons  determines  to  stick 
to  his  practice  until  the  pressure  lessens.  To 
enable  himself  to  do  so  he  resorts  to  stimulants, 
just  at  a  time  when  his  system  is  least  able  to 
resist  the  effects,  and  the  seeds  of  alcohohsm  are 
sown.  The  whole  process  is  repeated  again 
and  again,  until  he  finds  himself  in  the  toils.  It 
is  a  common  history  to  medical  superintendents 
of  inebriate  homes,  and  as  it  is  with  the  doctor 
so  it  is  with  the  overworked  business  man — no 
time  in  this  busy  world  of  strenuous  competition 
to  take  the  necessary  holiday.  They  do  not  for 
one  moment  intend  to  become  inebriates,  and 
always  expect  to  pull  themselves  up  sharply  at 
the  first  sign  of  danger,  but  unfortunately  for 
them  the   disease   is   an   insidious   one,  and   the 


8o  MODERN  TREATMENT  OF  ALCOHOLISM 

mischief  is  done  before  they  are  aware  of  it.  Many 
patients  date  their  inebriety  from  a  period  of 
convalescence  from  some  illness.  Wine  or  other 
alcoholic  stimulant  ordered  by  the  attending 
physician  is  taken,  and  often  the  result  is  inebriety. 
How  can  it  be  otherwise  when  one  considers  how 
very  sensitive  the  organism  is  to  the  poison  at 
such  a  time  ?  One  of  the  most  painful  cases  of 
inebriety  I  ever  saw  w^as  of  this  nature,  and  in 
a  teetotaller  too.  If  our  profession  could  only 
learn  to  order  alcohol  only  when  absolutely 
compelled  to  do  so,  instead  of  in  the  careless  way 
it  is  now  ordered,  I  am  convinced  there  would  be 
much  less  inebriety  in  the  world,  and  much  less 
suffering  accredited  to  the  profession.  I  find  I 
have  uttered  this  warning  before,  but  it  will  bear 
repetition. 

Syphilis  as  a  Cause  of  Inebriety 

Syphilis  is  a  more  frequent  cause  of  inebriety 
than  is  generally  supposed.  Some  of  those  who 
ccntract  syphiUs  are  highly  sensitive  men  and 
women,  with  very  exaggerated  views  of  its  prob- 
able effects.  Their  mental  sufferings,  whether 
they  be  from  remorse,  fear  of  discovery,  or  dread 
of  future  consequences,  are  acute,  and  induce  a 
condition  of  nerves  highty  suitable  to  the  growth 


THE  CAUSES  OF  INEBRIETY  8i 

of  alcoholism.  Or,  on  the  other  hand,  they  may 
totally  despair  of  ever  regaining  their  health, 
and  in  sheer  desperation  resort  to  drink.  I  am 
quite  convinced  that  the  contraction  of  this 
disease  by  some  has  a  most  demoralising  effect, 
breaking  down  the  last  barrier  of  self-respect, 
and  leading  to  a  consequent  reckless  plunge  into 
all  that  is  undesirable,  indulging  largely  in  spirits 
to  enable  them  to  temporarily  forget  their 
misery.  The  very  company  which  they  consort 
with  only  tends  to  encourage  their  drinking  habits, 
in  order  to  prey  upon  them  so  long  as  they  have 
money  to  spend — then  the  end  is  not  far  off ; 
the  whole  wretched  story,  beginning  in  one  un- 
fortunate indulgence — in  some  cases  their  very 
first  offence. 

The  Mental  Condition  as  a  Cause  of 
Inebriety 

It  is  a  well-known  fact  that  the  majority  of 

inebriates  are  above  the  average  in  cleverness. 

Take  a  family  of  three  or  four  sons  ;  there  may 

be  nothing  of  note  between  them  excepting  that 

one  is  markedly  more  clever  than  the  rest.     In 

health,  morals,  and  physique  there  is  no  difference, 

nor  yet  in  their  habits  or  surroundings.     Yet  if 

any  one  of  them  becomes  a  drunkard  it  is  almost 
6 


82  MODERN  TREATMENT  OF  ALCOHOLISM 

always  the  most  clever  one  of  the  lot.  The  very 
sensitiveness  of  his  psychic  functions  is  his  weak- 
ness if  he  indulges  at  all.  All  pathologists  writing 
on  the  subject  of  alcoholism  agree  that  it  is  the 
most  highly  organised  part  of  the  system  w^hich 
first  deteriorates  in  alcoholism,  and  it  may  be 
fairly  assumed  that  it  is  this  part  which  is  first 
affected  by  the  disease  ;  consequently,  if  one 
member  of  a  family  has  these  higher  centres 
more  highly  developed  than  the  rest  of  the  family, 
he  will  be  more  sensitive  to  the  poison  than  they 
are.  Whatever  the  reason,  the  fact  stands  that 
it  is  the  clever  one  who  most  often  contracts  the 
disease. 

But  there  is  another  class  whose  mental 
condition  makes  for  alcohohsm,  and  w^e  have  to 
travel  very  far  down  the  scale  to  reach  them  ; 
they  may  be  truly  termed  the  sots.  In  them  the 
animal  predominates  over  the  intellectual ;  they 
are  lustful  in  their  eating,  as  w^ell  as  in  their 
drinking  and  passions.  No  restraining  influences 
over  their  appetites  whatever,  they  eat  or  drink 
till  they  can  eat  or  drink  no  more,  provided 
they  can  get  it.  They  drink  themselves  drunk 
on  all  possible  occasions,  years  before  they  become 
the  subjects  of  a  genuine  craving  for  alcohol. 
They  can  do  without  it  if  it  is  not  obtainable, 
without   any   of   the   torture   undergone   by   the 


THE  CAUSES  OF  INEBRIETY  83 

real  inebriate  who  is  forced  to  abstain  ;  but  once 
the  real  craving  is  established,  they  suffer  like 
their  more  highly  endowed  fellow-victims.  Of 
course  one  finds  inebriates  among  all  grades  of 
mental  condition,  but  these  two  classes  stand  out 
prominently  by  themselves.  Their  mental  con- 
ditions are  the  extremes,  and  the  causes  of 
indulgence  are  equally  distant  one  from  the  other. 
While  on  this  subject  I  may  relate  a  pecuhar 
form  of  mental  condition  found  in  one  of  my 
patients.  He  asked  me  the  following  question : 
"  What  will  I  do  after  returning  home  if  any  one 
asks  me  to  have  a  drink  ?  "  There  was  nothing 
about  him  noticeably  different  from  other  men, 
and  I  did  not  take  the  question  seriously  at  first, 
but  he  soon  astonished  me  by  telling  me  he  was 
not  joking  but  meant  the  question  quite  seriously. 
When  I  replied  that  it  was  quite  easy  to  refuse 
a  drink  if  one  did  not  wish  to  take  it,  he  could 
only  say,  "  But,  doctor,  they  will  ask  me  to  have 
a  drink,  and  I  don't  see  how  I  can  refuse."  He 
assured  me  that  he  did  not  wish  to  take  it,  neither 
did  he  want  it,  but  was  quite  incapable  of  under- 
standing how  he  was  to  refuse  it,  although  he 
clearly  understood  the  danger  to  himself  in  not 
doing  so.  The  thing  was  a  genuine  worry  to 
him,  yet  from  some  peculiarity  of  his  mental 
condition  he  appeared  to  be   totally  unable   to 


84  MODERN  TREATMENT  OF  ALCOHOLISM 

see  how  he  was  to  refuse.  Another  case  of 
pecuhar  mental  condition  in  an  inebriate  was  that 
of  a  well-known  journahst  of  Toronto.  While 
undergoing  treatment,  two  incidents  occurred 
indicating  an  abnormal  mental  state.  While 
gardening  one  day  this  patient  asked  me  if  he 
might  help,  as  he  was  fond  of  gardening.  I  found 
he  was  not  only  very  fond  of  it,  but  had  a  very 
special  knowledge  of  roses.  We  were  working 
and  talking  in  a  most  pleasant  manner  when  I 
mentioned  the  word  "  Methodist."  Like  a  flash 
he  was  standing  over  me  ready  to  strike  with 
uplifted  hoe  and  a  face  distorted  with  fury.  To 
reach  me  he  had  crossed  the  flower-bed,  and  my 
appeal  to  him  not  to  crush  the  roses  instantly 
dissipated  his  fury  and  reduced  him  to  tears. 
He  then  explained  that  the  term  "  Methodist  '* 
always  had  this  effect  upon  him — a  fact  which  I 
saw  corroborated  later  on.  Now  this  man  was 
noted  for  his  kind-heartedness  and  gentle  manners, 
while  his  articles  for  the  press  were  full  of  solid 
common  sense  ;  but  I  had  no  doubt  in  my  own 
mind  that  his  inebriety  was  due  to  some  kink  in  his 
mental  condition,  and  this  I  was  able  to  verify 
later  on. 

The  specialist  meets  with  a  great  variety  of 
mental  conditions  in  the  inebriate,  and  to  attempt 
to  enumerate   them   would   mean   a   very   large 


THE  CAUSES  OF  INEBRIETY  85 

volume,  but  there  is  one  other  class  I  will  mention 
which  is  frequently  met  with,  namely,  those  who 
get  drunk  with  the  idea  of  "getting  even"  with 
those  with  whom  they  have  quarrelled  or  against 
whom  they  have  some  grievance,  fancied  or  real. 
By  some  peculiar  mental  process  they  convince 
themselves  that  the  injury  is  not  to  themselves 
but  to  others.  I  am  not  now  rigferrifig  to  cases 
where  the  action  of  the  drinker  would  affect 
some  one  interested  in  their  habits,  but  to  cases 
where  their  actions  do  not  concern  in  the  least 
those  against  whom  they  are  directed.  I  have 
met  a  number  of  these  cases. 

Environment  as  a  Cause  of  Inebriety 

Environment  not  only  acts  as  an  exciting  cause 
in  inebriety,  but  also  as  a  direct  cause  in  some 
cases.     As  an  exciting  cause  it  is  familiar  to  all. 

There  are  many  men  who  drink  because  their 
companions  are  drinking,  or  leave  it  alone  because 
the  others  do  so.  They  model  their  actions  upon 
the  action  of  those  about  them.  If  the  others 
drink  lightly,  they  are  apparently  quite  content 
to  do  likewise  ;  but  if  the  others  drink  deeply 
they  do  the  same.  They  do  this  not  only  in 
drinking  but  in  every  line  of  conduct.  They  are 
moral  while  their  companions  are,  or  the  reverse. 


86  MODERN  TREATMENT  OF  ALCOHOLISM 

They  appear  to  live  only  to  imitate  others  without 
any  particular  desire  to  do  so.     It  is  a  matter  of 
complete   indifference   to   them   personally   what 
they  do.     They  seem  to  have  no  individuahty 
whatever.     Now,  if  their  more  or  less  constant 
environment  be  that  of  deep  drinkers,  they  sooner 
or  later  become  inebriates,  and  their  very  lack  of 
will-power    makes    them    hopeless    cases.     Their 
only  hope  after  a  proper  course  of  treatment  is 
to  place  themselves  in  an  environment  of  total 
abstinence,     and    remain    there.     As    such     an 
environment    is    almost    impossible    outside    an 
inebriates  home,  they  ought  to  reside  there  for 
long   periods.     There    is   another   large   class   of 
men,  who,  while  they  are  not  mere  imitators  of 
their   associates,  and  while   they  possess   an  in- 
dividuality and  will-power  of  their  own,  yet  are 
strongly  influenced   by  their    environment,    and 
will  do  violence  to  all  their  finer  instincts  if  the 
influence   of   environment   is   sufficiently   strong. 
They   do  not  readily  become  inebriates,   but   a 
continuance  for  years  in  an  adverse  environment 
will    drift    them    into    inebriety.     This    is    w^ell 
illustrated   in    the    following    history   of    thirty 
hard-headed,  keen  business  men  of  the  city  of 
Toronto.     They    were    young    men    engaged    in 
business,  and  the  future  was  full  of  promise  for 
them.     They  met  at  the  same  restaurant  daily 


THE  CAUSES  OF  INEBRIETY  87 

to  dine,  and  it  was  their  custom  to  wish  each 
other  success  in  a  glass  of  wine  at  the  end  of  the 
meal.  As  their  friendship  grew  with  time,  they 
became  a  circle  unto  themselves  and  met  at 
more  frequent  intervals,  often  spending  their 
evenings  together  and  taking  a  whisky  and  soda 
with  their  pipes.  At  the  end  of  five  years  there 
was  no  noticeable  change  in  their  habits  ;  they 
were  all  still  keen,  hard-working  business  men 
who  were  making  money,  and  drank  with  the 
same  moderation.  As  time  rolled  by  a  change 
came  over  the  scene.  One  by  one  they  gradually 
began  to  indulge  more  freely  and  to  meet  more 
frequently,  often  at  the  expense  of  business. 
Finally  came  the  end.  Being  asked  to  see  one 
of  them,  I  found  him  with  but  a  few  hours  to 
live,  and  it  was  from  him  I  obtained  the  above 
history.  He  concluded  his  remarks  by  telling 
me  that  of  the  thirty  young  men  who  had  started 
life  so  hopefully,  twenty-eight  had  died  suddenly 
from  drink,  he  would  make  the  twenty -ninth, 
and  the  thirtieth  was  not  likely  to  survive  him 
by  many  months.  His  great  trouble  was  that 
he  and  his  companions  had  always  scouted  the 
idea  of  any  danger  arising  from  their  social 
habits,  and  in  consequence  he  could  not  tell  how 
many  young  men  had,  through  their  example 
and  emphatic  statements,  been  led  into  a  similar 


88  MODERN  TREATMENT  OF  ALCOHOLISM 

course,  the  danger  of  which  was  now  only  too 
apparent.  "  Not  one  of  us,"  he  continued,  "  ever 
dreamed  of  becoming  an  inebriate,  and  conse- 
quently encouraged  others  to  do  as  we  were  doing. 
If  I  could  only  recall  my  advice  to  those  young 
men  I  would  die  with  a  much  easier  conscience." 
The  last  of  the  thirty  died  of  delirium  tremens  a 
few  months  after.  Not  one  of  the  circle  reached 
fifty-five  years  of  age.  I  afterwards  met  people 
who  had  known  the  members  of  this  circle  in 
former  years,  and  they  corroborated  all  his 
statements.  No  doubt  this  is  a  very  exceptional 
history,  but  even  so,  it  is  a  very  striking  example 
of  how  environment  may  cause  inebriety.  I  knew 
some  of  these  men  personally,  and  am  convinced 
that  under  ordinary  circumstances  their  end 
would  have  been  far  different.  Force  of  example 
and  loyalty  to  each  other  no  doubt  played  a 
prominent  part  in  leading  them  into  excesses 
which  otherwise  they  would  have  resisted  in 
time  to  avoid  disaster.  It  is  needless  to  add 
that  their  business  suffered  and  failed  like  them- 
selves, and  the  last  of  them  became  so  poor  before 
he  died  that  he  was  unable  to  afford  a  fire  on  a 
cold  winter's  day.  The  other  side  of  the  picture 
is  well  illustrated  by  the  following  statement 
made  by  a  friend  of  mine.  He  was  visiting 
Canada  a  few  years  ago,  and  stayed  at  a  leading 


THE  CAUSES  OF  INEBRIETY  89 

hotel  in  a  large  city.  When  at  home  here  he 
regularly  took  a  small  Bass  with  his  lunch,  and 
for  a  day  or  two  did  the  same  abroad.  Being  a 
stranger  in  the  country,  it  occurred  to  him  to 
look  and  see  what  the  Canadians  drank  at  lunch. 
To  his  surprise  he  found  himself  the  only  one 
drinking  an  alcoholic  beverage  in  a  large  dining- 
room  full  of  people.  He  ceased  to  order  his  Bass, 
as  he  said  he  did  not  wish  to  make  himself  con- 
spicuous. On  inquiry,  he  was  told  that  business 
men  largely  used  the  hotel  to  meet  the  repre- 
sentatives of  wholesale  houses  from  other  parts, 
and  that  it  was  considered  detrimental  to  their 
credit  to  be  seen  taking  intoxicants ;  whether  they 
did  so  secretly  or  not  is  another  matter.  The  point 
is  that  the  ordinary  travelling  public,  of  whom 
there  was  always  a  fair  proportion  present,  felt  the 
influence  of  this  teetotal  environment  sufficiently 
to  cause  them  to  forego  their  usual  beverage.  One 
can  hardly  imagine  a  similar  scene  in  the  City 
of  London,  no  matter  how  desirable  it  might  be. 
Yet  one  may  hope  to  some  day  see  a  similar  scene 
even  here  in  London,  for  the  indications  are  that 
matters  are  improving  in  that  direction.  The 
following  will  illustrate  this :  A  patient  of  mine, 
a  broker,  informed  me  that  at  one  time  he  did 
not  hesitate  to  call  upon  his  customers  with  the 
smell  or  signs  of  drink  on  him,  but  that  during 


go  MODERN  TREATMENT  OF  ALCOHOLISM 

the  last  few  years  prior  to  his  taking  the  treatment 
there  was  an  increasing  number  of  his  customers 
who  would  at  once  have  ceased  to  do  business 
with  him  if  they  had  noted  the  odour  of  drink 
about  him,  and  he  informed  me  that  he  cunningly 
saw  all  these  early  in  the  day,  because  he  knew 
that  sooner  or  later  he  would  be  taking  his  whisky 
and  soda.  He  assured  me  that  from  his  own 
personal  knowledge  there  was  a  marked  change 
in  the  habits  of  the  City  men  during  the  last 
fifteen  years.  It  is  to  be  sincerely  hoped  that 
this  improvement  may  rapidly  grow  to  large 
dimensions,  for  any  one  acquainted  with  the 
present  state  of  things  knows  what  a  large  part 
environment  plays  there  in  the  ruining  of  many 
promising  careers  through  drink. 

Even  the  class  of  women  who  in  England 
think  nothing  of  entering  our  public-houses  for 
drink  cease  to  do  so  on  emigrating  to  Canada. 
Here  it  is  a  common  practice ;  there  no  woman 
ever  does  it.  And  if  one  asks  Canadian  visitors 
to  this  country  what  strikes  them  most  forcibly 
in  our  social  customs,  they  almost  invariably 
remark,  "  I  cannot  understand  why  women 
degrade  themselves  by  entering  public-houses." 
If  the  w^omen  of  our  lower  classes  lived  in  an 
environment  similar  to  that  of  their  class  in 
Canada,  they  would  cease  to  visit  public-houses. 


THE  CAUSES  OF  INEBRIETY  91 

and  thereby  immensely  lessen  the  risk  of  their 
becoming  inebriates.  It  was  not  always  so  in 
Canada,  but  education  and  example  have  changed 
the  whole  question.  Every  child  is  taught  in 
school  the  evils  and  dangers  of  alcoholic  beverages, 
and  grows  up  in  an  environment  of  the  most 
favourable  sort,  with  the  result  that  a  large 
proportion  of  the  youth  of  the  country  do  not 
know  the  taste  of  any  form  of  alcohol,  and  look 
upon  one  who  does  indulge,  even  moderately, 
as  already  on  the  road  to  damnation.  What 
drinking  there  is  among  the  youth  of  Canada  is 
largely  confined  to  newxomers  who  have  brought 
the  habit  with  them  from  abroad,  and  many  of 
these  find  the  environment  so  strong  that  they 
soon  become  teetotallers.  Without  so  doing  it 
would  be  very  difficult  for  them  to  obtain  or 
hold  positions  in  business.  I  am  referring  mainly 
to  Ontario,  the  only  province  of  which  I  have  a 
personal  knowledge.  Whether  the  same  holds 
good  in  the  great  North- West  I  cannot  say,  but 
I  have  been  led  to  infer  that  it  is  so. 

Worry  and  Trouble  as  a  Cause  of 
Inebriety 

That  worry  and  trouble  is  a  cause  of  inebriety 
is  apparent  on  the  face  of  it.     The  old  saying, 


92  MODERN  TREATMENT  OF  ALCOHOLISM 

that  "  work  seldom  kills  but  worry  often  does/' 
is  more  true  to-day  than  ever.  Also  another 
old  saying,  "  that  the  weak  must  go  to  the  wall," 
is  more  evident  now  than  in  the  former  easy- 
going days.  The  strenuous  competition  necessary 
to  obtain  a  living  to-day  is  tearing  our  nerves 
to  pieces.  The  husband  not  only  suffers  from 
this,  but  the  wife  and  children.  The  wife  finds 
it  a  greater  strain  to  manage  her  household  on 
the  lessened  income,  and  when  both  parents 
suffer,  the  offspring  are  bound  to  suffer  also. 
Weakened  will-power  follows  weakened  nerve- 
force,  and  in  a  country  where  stimulants  are  as 
much  in  daily  use  as  tea  or  coffee,  the  inroads 
of  alcoholism  are  greater.  Another  factor  is  the 
increased  number  of  those  who  find  the  struggle 
a  hopeless  one  and  give  up  in  despair,  and  while 
a  number  of  these  end  the  matter  by  taking  their 
lives,  others  from  various  motives  refrain  from 
such  a  drastic  remedy  and  dro\\'n  their  sorrows 
in  drink,  or  at  least  endeavour  to  do  so,  indifferent 
to  the  consequences  of  their  folly.  Our  slums  are 
eloquent  of  this  state  of  affairs,  but  one  does  not 
need  to  go  to  the  slums  in  order  to  meet  with 
these  conditions.  Business  men  provide  plenty 
of  examples ;  the  worry  and  nerve-strain  of 
increasing  competition  is  often  met  with  freer 
indulgence  in  alcohol,  and  this  being  so  among 


THE  CAUSES  OF  INEBRIETY  93 

the  middle  classes  one  cannot  wonder  at  it  among 
the  lower  classes,  where  the  opportunities  for 
success  are  on  a  much  lower  scale.  Every  medical 
man  knows  of  such  cases,  and  doctors  themselves 
are  far  too  often  victims  of  the  same  trouble. 
Stock  Exchange  men,  so  I  am  informed,  contribute 
an  undue  share  of  this  class  of  inebriates.  If  this 
is  true,  one  can  readily  understand  how  the  nervous 
strain  they  are  often  subject  to  leads  to  an  unusual 
use  of  stimulants,  and  its  only  too  often  resulting 
in  inebriety.  Knowing  the  effect  of  nerve-strain, 
one  would  not  be  surprised  if  one  heard  of  cases 
of  inebriety  resulting  from  the  all-night  sittings 
of  the  late  Parliament.  More  than  one  case  can 
be  recalled  by  me  of  inebriety  resulting  from  the 
worry  and  strain  of  watching  some  dear  one 
through  a  dangerous  illness.  The  loss  of  sleep, 
anxiety,  and  nerve-strain  are  strong  factors  in 
the  production  of  that  condition  of  body  and  mind 
favourable  to  the  contraction  of  inebriety.  Cases 
are  on  record  of  sea-captains  who  have  become 
inebriates  in  consequence  of  a  prolonged  strain 
in  bringing  their  ships  safely  into  harbour.  The 
same  thing  is  known  of  brave  men,  who,  being 
responsible  for  the  soldiers  under  them  and  w^ho 
have  been  placed  in  hazardous  places,  where  for 
a  lengthened  period  their  vigilance  must  not 
cease   day   or   night,   have   been  caught   on   the 


94  MODERN  TREATMENT  OF  ALCOHOLISM 

rebound  after  being  relieved.  Even  students 
have  been  known  to  become  inebriates  through 
breaking  down  when  preparing  for  an  exam.  I 
well  remember  the  advice  given  by  one  of  the 
leading  physicians  when  a  student  at  the  London 
Hospital.  He  said,  "  If  you  are  working  too 
hard  and  feel  the  strain,  relax  it  by  getting  drunk." 
In  the  light  of  my  present  knowledge  of  drinking, 
I  seriously  question  the  wisdom  of  such  advice. 
Relax  the  strain  certainly,  but  relax  it  in  any 
other  way,  for  it  is  just  in  such  a  condition  of 
the  nerves  when  alcohol  does  most  harm. 


Social  Customs  as  Causes  of  Inebriety 

This  is  such  a  well-known  cause  of  inebriety 
that  one  feels  like  apologising  for  enlarging 
upon  it,  yet  every  specialist  in  inebriety  knows 
that  the  number  of  people  who  scout  the  idea  of 
danger  in  the  mere  social  use  of  stimulants  is 
far  larger  than  is  generally  supposed,  and  it  is 
possible  that  some  who  read  this  book  may 
be  among  the  number,  and  may  thereby  see 
reason  to  change  their  views  on  this  matter. 
I  have  already  mentioned  something  of  the  social 
custom  of  Ontario,  but  it  may  astonish  many  at 
home  here  to  learn  that  one  may  travel  through 
the  length  of  that  beautiful  and  fertile  province; 


THE  CAUSES  OF  INEBRIETY  95 

visiting  house  by  house,  whether  in  city  or 
village,  and  not  be  offered  a  single  glass  of 
stimulant  in  ninety  out  of  every  hundred  homes. 
This  also  applies  equally  to  the  farmhouses. 
This  is  not  due  to  any  lack  of  hospitality,  for 
there  are  no  more  hospitable  people  anywhere. 
It  is  simply  due  to  the  fact  that  they  neither  use 
it  nor  keep  it  in  the  house,  unless  one  here  and 
there  finds  a  little  brandy  locked  up  in  view  of 
sudden  illness.  It  is  simply  the  custom  of  the 
country.  In  contrast  to  this,  what  is  our  own 
custom  ? — practically  the  reverse.  An  English 
host  or  hostess  could  not  understand  hospitality 
without  it,  and  a  wine-cellar  is  as  essential  to  all 
English  houses  of  the  well-to-do  class  as  an 
ice-house  is  to  a  Canadian  home.  It  is  largely 
our  custom  to  offer  stimulants  to  a  guest,  no 
matter  what  time  of  the  day  or  night  he  may 
visit  our  homes.  The  custom  is  unnecessary, 
unwise,  and  dangerous.  It  is  unnecessary, 
because  in  those  homes  where  it  is  never  used 
the  hospitality  does  not  suffer  from  its  absence. 
It  is  unwise,  because  of  its  example  to  children, 
and  because,  if  there  is  a  weak  one  in  the  family, 
the  temptation  is  always  present,  and  it  is 
dangerous  because,  owing  to  the  very  force  of  the 
custom,  many  guests  dishke  to  offend  by  refusing, 
and  among  them  are  often  those  who  are  already 


96  MODERN  TREATMENT  OF  ALCOHOLISM 

fighting  against  its  inroads,  and  the  intended 
hospitahty  may  start  an  attack  of  drinking  and 
all  its  consequences.  A  host  or  hostess  with 
the  kindest  intentions  in  the  world  may  thus  be 
indirectly  the  cause  of  much  suffering  and  sorrow, 
and  in  a  few  cases  even  of  murder. 

It  is  unwise  to  assert  that  because  you 
can  take  alcohohc  beverages  regularly  without 
apparent  harm,  that  all  others  can  do  the  same, 
and  yet  those  who  honestly  believe  and  em- 
phatically assert  such  a  principle  form  a  very 
large  proportion  of  our  population.  They  forget 
the  old  teaching  that  "  what  is  one  man's  meat 
is  another  man's  poison."  In  this  concise  state- 
ment we  find  the  whole  truth  of  the  danger  of  our 
social  habits  regarding  stimulants.  It  is  quite 
true  that  some  of  us  can  use  stimulants  moder- 
ately for  a  long  lifetime  without  apparent  harm, 
but,  reversely,  the  same  amount  of  stimulants 
daily  will  produce  inebriety  in  others  before 
they  come  of  age,  or  at  various  ages  upwards. 
One  of  my  patients  was  a  youth  of  seventeen, 
who  was  a  confirmed  inebriate  at  sixteen.  He 
used  stimulants  in  the  same  manner  as  the  rest 
of  the  family,  and,  while  none  of  them  became 
excessive  drinkers,  yet  he  was  seized  one  day 
with  an  uncontrollable  appetite  for  alcohol,  the 
gratifying  of  which,  owing  to  his  youth,  nearly 


THE  CAUSES  OF  INEBRIETY  97 

killed  him.  We  all  know  of  families  where  the 
social  custom  produces  inebriety  in  one 
member,  while  having  no  apparent  effect  on  the 
others.  Surely  it  is  fair  to  assume  that  these 
victims  would  have  escaped  under  different 
social  customs.  Years  before  pathology  had 
shown  us  the  steady  destructive  effects  of  daily 
drinking,  even  in  moderate  quantities,  my  ex- 
perience of  alcohohsm  had  led  me  to  the  con- 
clusion that  the  daily  use  of  stimulants  would 
make  inebriates  of  every  such  user,  providing 
they  lived  long  enough.  The  facts  all  point  in 
that  direction.  Life  insurance  companies  prefer 
a  teetotaller  to  the  moderate  drinker,  other 
things  being  equal.  The  moderate  drinker  runs 
a  greater  risk  of  dying  in  certain  illnesses  than  a 
teetotaller  ;  he  does  not  stand  a  serious  surgical 
operation  so  well ;  he  cannot  withstand  excessive 
cold  or  heat  in  the  same  way  as  a  teetotaller, 
neither  will  he  undergo  the  same  strain  or  hard- 
ships as  well  as  a  non-user  of  stimulants.  The 
cutting  off  of  all  alcohol  during  training  for  severe 
athletic  tests  shows  clearly  how  its  use  prevents 
perfect  vitality.  If  these  things  are  so  (and 
there  is  no  question  of  their  being  facts),  then  it 
is  evident  that  even  very  moderate  indulgence 
has  a  deteriorating  effect,  and  therefore  the  social 
custom  of  such  moderate  use  of  stimulants  is 
7 


98  MODERN  TREATMENT  OF  ALCOHOLISM 

both  unwise  and  dangerous.  One  often  hears 
the  remark,  "  Oh,  I  only  take  a  httk  wine  (or 
spirits  or  ale)  daily  !  "  One  of  the  saddest 
cases  I  remember  was  that  of  a  man  who  never 
exceeded  two  glasses  of  ale  a  day,  never  used 
wine  or  spirits,  and  only  took  his  ale  with  his 
meals — one  glass  at  lunch  and  another  at  dinner  ; 
yet  he  died  of  alcoholic  dropsy.  It  is  not  the 
quantity  taken  so  much  as  the  effect  on  the 
individual,  and  I  would  like  to  warn  those  who 
are  so  confident  of  escaping  the  evil  effects  of 
alcohol  simply  because  they  are  very  moderate 
users,  that  no  one  can  say  what  the  effect  of 
that  small  quantity  will  be  in  any  one  individual. 
The  effect  upon  the  individual  will  vary  w^ith 
the  circumstances  in  which  it  is  taken.  The 
effect  will  be  greater  if  taken  on  an  empty 
stomach  than  if  taken  with  food  ;  greater  if 
taken  neat  than  diluted  ;  greater  to  the  sedentary 
clerk  shut  up  indoors  all  day  than  to  the  bus 
or  cab  driver  who  lives  in  the  open  air  ;  greater 
to  the  town  dweller,  though  he  be  out  of  doors 
all  day,  than  to  the  man  out  in  the  country  air 
all  day ;  and  greater  to  the  open-air  dweller  in 
the  country  if  he  resides  in  a  valley  than  if  he 
lives  on  the  moors — all  other  things  being  equal. 
The  reasons  for  these  different  effects  of  a  similar 
quantity  of  a  similar  stimulant  are  well  known 


THE  CAUSES  OF  INEBRIETY  99 

to  iiiedical  men,  but  cannot  be  further  detailed 
in  a  small  work  like  this.  As  no  medical  man, 
let  alone  the  moderate  drinker  himself,  can  know 
positively  the  precise  effect  of  alcohol  in  any 
given  case,  it  follows  that  there  is  only  one  sure 
way  to  avoid  the  evil  effects  of  indulgence,  and 
that  is  by  abstaining  altogether.  No  amount  of 
apparently  harmless  effect  upon  others  is  a  safe 
guide  to  the  individual. 

Before  leaving  the  question  of  social  custom  as 
a  cause  of  inebriety,  I  would  like  to  offer  a  w^ord 
of  advice  to  certain  of  my  readers — firstly  as  a 
medical  man,  and  secondly  as  a  specialist  who 
has  spent  years  exclusively  in  the  treatment  of 
inebriety. 

To  the  hostess  I  would  say,  do  not  let  your 
hospitality  induce  you  to  press  upon  or  even 
offer  stimulants  to  the  reluctant  guest.  His 
dislike  of  refusing  may  induce  him  to  accept 
that  which  sad  experience  has  taught  him  to 
avoid.  A  friend  should  never  feel  offended 
because  his  friend  refuses.  A  medical  man 
should  never  prescribe  alcoholic  stimulants  where 
any  objection  is  made  by  either  patient  or  family. 
A  business  man  will  be  well  advised  if  he  ceases 
to  expect  every  one  with  whom  he  does  business 
to  do  it  over  a  whisky-and-soda.  An  employer 
ought  not  to  offer  stimulants  to  his  employee, 


100  MODERN  TREATMENT  OF  ALCOHOLISM 

or  a  clerk  to  his  fellow-clerk,  or  the  servant  of 
a  railway  company  to  another  servant,  or  even 
a  navvy  to  his  mate.  These  are  a  few  of  the 
many  instances  where  experience  has  shown 
that  the  intended  kindness  may  be  the  beginning 
of  untold  misery.  If  we  knew  the  exact  effect 
in  each  case,  the  whole  question  would  be  very 
different ;  but  we  do  not  know,  and  therefore 
should  learn  from  the  sad  experience  of  others 
not  to  allow  our  intended  kindness  to  outweigh 
our  discretion,  or  induce  us  to  risk  ruining  the 
whole  future  of  others. 


Religious  Observances  as  a  Cause  in 
Inebriety 

There  is  one  more  cause  of  inebriety  which  I 
would  like  to  mention,  if  only  as  a  warning  to 
those  who  would  be  the  very  last  to  injure  their 
fellow-men  knowingly,  namely,  the  clergy.  One 
naturally  hesitates  to  associate  a  sacred  rite  hke 
the  Lord's  Supper  with  inebriety,  let  alone 
mention  it,  yet  I  do  so  in  the  hope  that  what  I  am 
about  to  relate  may  lead  to  the  substitution  of 
unfermented  for  fermented  wine  in  a  larger 
number  of  churches  than  holds  at  the  present 
time. 

I   am   not   qualified   to   discuss   the    religious 


THE  CAUSES  OF  INEBRIETY  loi 

aspect  of  the  question,  nor  is  it  within  my  province, 
but  merely  to  point  out  the  danger  from  a  medical 
aspect  and  then  leave  it  to  the  conscience  of  the 
clergy.  I  have  been  told  by  clergymen  that  the 
small  sip  of  wine  taken  at  Communion  cannot 
possibly  have  any  influence  upon  the  drinking 
habits  of  the  communicant.  While  this  is  un- 
doubtedly true  of  the  great  majority  of  cases,  it  is 
not  true  of  all.  There  are  some  individuals  so 
sensitive  to  the  action  of  wine  that  even  such  a 
small  quantity  as  that  taken  at  church  runs 
through  their  veins  like  liquid  fire,  and  arouses 
the  demon  within  them  as  surely  as  a  larger 
amount  does  in  less  sensitive  users.  This  seems 
incredible,  and  I  did  not  believe  it  myself  at  one 
time,  but  I  now  know  it  to  be  a  fact.  If  we  turn  for 
a  moment  to  another  narcotic,  namely,  morphine, 
we  find  it  on  record  that  one  injection  of  Jth  grain 
affected  the  patient  to  the  extent  of  making  him  a 
morphine  victim  there  and  then.  The  same  is 
known  of  cocaine.  The  disturbance  to  the  system 
of  one  small  dose  has  been  so  profound,  that  from 
then  onwards  the  victims  could  not  resist  its 
use.  I  admit  that  these  are  very  exceptional 
cases,  but  I  am  now  writing  about  exceptional 
cases.  The  above  drug  cases  were  without  any 
previous  experience  of  the  drugs,  while  the  cases 
which  are  affected  by  the  sacramental  wine  are 


102  MODERN  TREATMENT  OF  ALCOHOLISM 

already  fighting  against  the  narcotic.  It  is  also  a 
fact  that  the  very  odour  of  fermented  wine  as  the 
chalice  is  raised  to  the  lips  is  known  to  have  the 
most  potent  effect  upon  some,  causing  an  in- 
stantaneous breakdown  of  all  their  will-power, 
and  lighting  up  within  them  an  uncontrollable 
desire  to  indulge  ;  some  of  them  have  been 
known  to  do  so  there  and  then,  causing  them  to 
take  not  a  sip  but  a  draught  of  the  wine,  while  in 
one  case  known  to  me  the  communicant  could  not 
resist  until  he  had  drained  the  cup.  It  is  on 
account  of  these  exceptional  cases  that  I  hope  to 
see  the  day  when  unfermented  wine  alone  will  be 
used.  I  have  had  some  of  these  cases  under  my 
care,  and  if  I  had  doubted  their  evidence,  which  I 
did  not,  I  had  a  personal  knowledge  of  these  things 
in  the  sad  death  of  a  dear  friend  of  mine.  He 
had  been  a  victim  to  alcoholism,  but  for  two  years 
had  not  touched  a  drop.  His  wife  pressed  him  to 
attend  a  Communion  Service  one  Sunday.  She 
afterwards  told  me  that  he  accompanied  her  with 
great  reluctance,  although  he  delighted  in  attend- 
ing the  ordinary  services.  At  the  time  she  did 
not  suspect  the  reason  of  this  reluctance,  although 
she  discovered  it  before  his  death.  The  effect 
of  either  the  fumes  of  the  wine  or  its  taste  was  so 
marked  as  to  lead  him  to  an  immediate  outbreak 
of  drinking,  which  ended  in  an  attack  of  delirium 


THE  CAUSES  OF  INEBRIETY  103 

tremens.  While  delirious  he  evaded  the  attend- 
ant and  leapt  from  an  upper  window  into  the 
street  below,  and  was  carried  into  the  house  in  a 
dying  condition.  Well  and  happy  one  Sunday, 
dead  the  next ! 

When  such  sad  cases  are  known  to  occur, 
surely  we  are  justified  in  pleading  for  the  use  of 
only  unfermented  wines  in  all  Communion  Services. 
The  fact  that  some  have  been  known  to  attend 
Communion  Services  for  the  sake  of  the  mouthful 
of  wine  is  not  of  material  consequence  from  a 
medical  point  of  view,  for  these  would  take  the 
wine  wherever  they  could  get  it,  and  their  habits 
do  not  necessarily  concern  the  question  of  the 
use  of  one  or  the  other  sort  of  wine  at  Com- 
munion. 


CHAPTER   IV 

FORMS  OF  INEBRIETY 

In  classifying  inebriety,  some  writers  give  a  long 
list,  but  I  cannot  see  that  any  useful  end  is  served 
by  multiplying  the  divisions  and  subdivisions. 
On  the  contrary,  I  believe  in  as  simple  a  division 
as  possible,  and  find  no  difficulty  in  placing  all 
alcoholic  inebriates  under  one  of  the  following 
five  divisions : 

1.  The  constant  drinker. 

2.  The  periodical  drinker. 

3.  The  dipsomaniac. 

4.  The  voluntary  drinker. 

5.  Mixed  cases. 

The  Constant  Drinker 

In  this  division  may  be  placed  all  those  inebri- 
ates whose  disease  leads  them  into  a  daily  in- 
dulgence in  stimulants.  They  feel  the  need  of 
the  narcotic  upon  awakening  each  morning,  and 
as  the  effect  of  each  drink  wears  off  during  the 


FORMS  OF  INEBRIETY  105 

day  they  feel  the  need  of  another,  and  this  con- 
dition persists  throughout  the  days  of  the  year. 
There  is  no  period  of  the  twelve  months  in  which 
they  are  indifferent  to  alcohol,  and  if  from  any 
cause  they  are  deprived  of  it  they  are  conscious 
of  a  deficiency  in  their  economy,  the  absence  of 
something  which  they  find  necessary  to  enable 
them  to  act  and  feel  normal.  The  term  normal  is 
not  a  correct  one,  for  no  inebriate  can  possibly  be 
normal,  but  it  is  the  only  one  which  conveys  a 
clear  idea  of  how  the  inebriate  feels  when  he  has 
had  just  enough  alcohol  to  steady  his  shaky  hand, 
clear  his  confused  brain,  sharpen  his  appetite 
for  food,  and  tone  up  his  nerves  generally.  De- 
prive him  of  this  necessary  amount  of  alcohol, 
and  he  is  like  a  piece  of  machinery  working  with 
all  the  connections  loose — there  is  a  jarring  and 
jolting  of  the  whole  machine  ;  but  stoke  him 
with  the  right  amount  of  alcohohc  fuel,  and  like 
the  adjusted  machine  he  steadies  down,  and  if 
the  working  is  not  perfect  at  least  gives  a  passable 
performance.  There  is  no  period  during  the 
whole  year  in  which  the  victim  is  absolutely  free 
from  bondage.  He  may  by  the  exercise  of  will- 
power or  under  the  influence  of  some  powerful 
motive  cease  to  indulge  for  a  longer  or  shorter 
time,  but  during  the  whole  of  this  period  of 
abstinence  he  is  more  or  less  conscious  of  what 


io6  MODERN  TREATMENT  OF  ALCOHOLISM 

we  term  craving,  and  although  his  general  health 
may  improve  owing  to  more  regular  habits  in 
eating  and  sleeping,  coupled  with  the  absence  of 
the  narcotic,  yet  he  will  tell  you  that  there  is  a 
feeling  of  something  wanting  which  he  finds 
difficult  or  impossible  to  satisfy.  This  is  not 
caused  by  the  mere  cessation  of  a  daily  habit, 
although  that  may  in  part  account  for  his  feelings  ; 
it  is  due  to  something  far  more  deeply  rooted 
than  habit,  for  it  comes  from  the  man's  very 
nerve  cells  themselves.  It  is  a  real  hunger  of  the 
cells,  calling  for  the  narcotic  with  which  they  have 
been  supplied  so  regularly  and  so  long  that  they 
have  ceased  to  provide  for  themselves,  and  have 
learned  to  depend  upon  this  constant  supply. 
This  craving  is  an  expression  of  the  sensory  nerve 
cells.  It  is  well  known  that  the  effect  of  coddling 
any  part  of  the  human  system  is  to  make  that 
part  less  resistant  against  the  very  forces  from 
which  it  has  been  screened.  An  unnecessary 
amount  of  clothing  worn  makes  the  wearer  less 
resistant  to  cold  ;  living  in  overheated  rooms 
causes  an  undue  sensitiveness  to  draughts,  etc. 
So  it  is  with  the  alcoholic.  He  coddles  his  sensory 
nerves  with  the  benumbing  effects  of  alcohol,  and 
thereby  lessens  the  transmission  to  the  brain 
centres  of  uncomfortable  sensations  from  different 
parts  of  the  body.     He  feels  more  comfortable 


FORMS  OF  INEBRIETY  107 

because  he  has  cut  the  communication  between  the 
brain  and  the  more  or  less  uncomfortable  parts 
beyond.  By  constant  repetition  of  this,  the 
sensory  nerve  cells  become  hypersensitive,  and 
when  there  is  a  temporary  withdrawal  of  the 
narcotic  they  are  more  sensitive  to  the  usual 
stimuli,  and  he  feels  what  he  terms  a  craving.  He 
terms  it  a  craving  because  he  knows  that  alcohol 
will  stop  it  for  a  time,  i.e.  for  so  long  as  there 
is  sufficient  left  in  the  system  to  benumb  these 
cells. 

In  this  division  of  alcoholics  the  craving  is 
present  whenever  the  supply  is  stopped.  This 
craving  is  present  in  many  men  who  not  only  are 
not  aware  of  it  themselves,  but  sincerely  pity 
others  in  whom  they  recognise  its  presence. 
Take  the  large  class  of  City  men  who  do  their 
business  over  a  glass  of  wine  or  a  whisky-and- 
soda.  These  drinks  are  repeated  again  and 
again  during  the  day  as  a  mere  adjunct  to  doing 
business.  It  becomes  a  daily  custom  to  them, 
just  as  eating  their  meals.  After  this  has  gone 
on  for  a  few  years,  tell  one  of  these  men  that  he 
has  become  an  inebriate  and  he  indignantly  pro- 
tests, but  ask  him  to  test  the  matter  by  voluntarily 
abstaining  for  a  month,and  he  is  surprised  by  find- 
ing himself  possessed  of  a  craving  for  stimulants. 
This  is  the  test  I  always  apply  in  such  cases.     If 


io8  MODERN  TREATMENT  OF  ALCOHOLISM 

he  does  not  miss  the  alcohol  during  the  month  of 
abstinence,  and  if  he  finds  his  nerves  as  steady 
without  as  with  it,  then  he  has  not  yet  contracted 
the  disease  ;  but  if,  as  many  do,  he  finds  himself 
not  up  to  the  mark  in  various  ways,  he  is  already 
a  victim  and  differs  from  the  poor  inebriate  whom 
he  so  sincerely  pities,  or  maybe  condemns,  only 
in  degree — a  degree  which  time  and  indulgence 
may  rapidly  obliterate.  If  any  of  the  many  who 
boast  of  their  abihty  to  take  alcohol  daily  without 
harm,  and  who  scorn  the  poor  fool  who  cannot  do 
the  same,  will  try  the  simple  test  which  I  have 
mentioned,  they  may  find  a  painful  surprise  in 
store  for  them. 

That  this  craving  once  established  lasts  for 
years  after  a  total  abstention  from  all  forms  of 
alcoholic  stimulants,  is  well  illustrated  by  the 
following  history  of  a  man  I  knew.  The  daily 
indulgence  in  alcohol  as  an  aid  to  business  led  to 
inebriety,  but  by  the  use  of  a  powerful  self-will 
and  the  aid  of  friends  he  succeeded  in  remaining 
teetotal  for  some  five  years.  At  this  time  he 
felt  convinced  that  he  had  entirely  outgrown  all 
his  former  weakness  for  the  stimulant.  Being  a 
journalist,  he  was  asked  to  report  upon  the 
business  of  a  large  City  firm,  to  do  which  it  was 
necessary  for  him  to  enter  some  wine  vaults.  He 
did  so  without  hesitation  and  without  fear,  but 


FORMS  OF  INEBRIETY  109 

had  not  been  in  them  above  five  minutes  when  the 
fumes  of  alcohol  awoke  such  a  powerful  craving 
within  him  that  he  rushed  from  the  place  like  a 
madman,  jumped  into  the  first  conveyance  he 
could  find  for  home,  and  when  he  reached  his 
home  rushed  upstairs  to  his  bedroom,  locked  the 
door  and  threw  the  key  out  of  the  window,  and 
for  three  days  dared  not  leave  the  house,  for  fear 
he  would  go  straight  to  the  nearest  public-house 
and  get  drunk.  Since  then  he  has  wisely  avoided 
all  likely  places  of  temptation.  This  is  no  doubt 
an  exceptional  case,  but  we  may  justly  infer  from 
it  that  the  craving  once  established  may  continue 
latent  for  years  in  those  who  have  ceased  to  use 
the  stimulant  which  produced  it,  and  that  the 
least  indulgence  on  their  part  may  lead  to  a 
lighting  up  of  all  the  old  trouble. 

The  second  division  is  that  of  the  Periodical 
Inebriate.  The  sufferers  from  this  form  differ 
from  the  last  in  one  essential  point,  namely,  the 
entire  absence  of  any  noticeable  craving  between 
the  attacks.  This  absence  of  craving  may  be  so 
marked  as  to  amount  to  a  strong  disHke  towards 
stimulants,  and  even  towards  those  who  regu- 
larly drink  to  excess.  There  is  one  very  marked 
feature  of  this  class  of  inebriates,  namely,  the  great 
contrast  between  their  mental  condition  during 
the  attacks  and  the  period  between  them.     Men 


no  MODERN  TREATMENT  OF  ALCOHOLISM 

and  women  who  between  the  attacks  are  without 
reproach  morally  and  religiously,  become  grossly 
immoral  and  profane  during  the  attacks.  They 
will  also  steal  and  lie  with  the  utmost  readiness, 
and  when  detected  in  any  of  these  faults  appar- 
ently are  incapable  of  feeling  shame.  These  are 
the  extreme  ones.  There  are  many  grades  of 
contrast,  but  even  in  the  lighter  cases  the  differ- 
ence is  decidedly  marked.  Some  who  when  sober 
are  most  fastidious  in  dress,  most  cleanly  in 
habits,  and  most  particular  in  selecting  associates, 
become  the  reverse  while  drinking,  and  seek  the 
company  of  the  vilest  and  low^est,  with  whom 
they  associate  in  the  closest  possible  manner. 
To  illustrate  this  contrast,  I  will  mention  three 
cases  of  which  I  have  a  personal  knowledge. 
The  first  was  that  of  a  young  man  thirty  years  of 
age  of  the  upper  middle  class.  Educated  in  a 
good  school  and  accustomed  to  associate  with 
people  of  his  own  class,  he  had  naturally  good 
tastes  and  correct  manners,  and  was  most  par- 
ticular about  his  personal  appearance  and  the 
status  of  those  with  whom  he  associated.  He 
was  one  of  the  most  difficult  to  please  regarding 
his  clothes  of  any  man  I  ever  met,  and  w^ould 
change  regularly  several  times  a  day.  He 
strongly  objected  to  anything  but  the  best  money 
could  provide  in  everything ;  yet  as  soon  as  an 


FORMS  OF  INEBRIETY  iii 

attack  of  drinking  commenced,  he  made  tor  one 
of  the  vilest  and  lowest  of  London  slums,  and  as 
long  as  the  attack  lasted,  unless  forcibly  removed 
by  his  friends,  would  live  the  life  of  those  about 
him  ;  but  as  soon  as  the  attack  abated  he  returned 
home  and  resumed  his  normal  character.  Yet 
this  man,  who  would  sleep  in  the  filthiest  of  beds, 
eat  the  dirtiest  of  food,  and  go  unwashed  and  un- 
shaved  for  days,  would,  when  sober,  object  to 
anything  short  of  immaculate  linen  and  the 
daintiest  of  food,  and  I  once  heard  him  complain 
of  having  to  walk  the  same  streets  as  poor  people. 
On  one  occasion  I  was  about  to  lean  on  the 
parapet  of  the  Embankment  in  order  to  watch 
the  river  life,  when  he  stopped  me  with  a  look 
of  horror  on  his  face,  saying,  "  Don't  do  that ! 
Think  of  the  filthy  people  who  may  have  leaned 
there  before  you."  Could  any  contrast  be  greater? 
The  second  case  was  that  of  a  member  of  the  legal 
profession,  who  by  his  superior  talent  had  attained 
to  a  very  high  rank.  Ordinarily  a  perfect  gentle- 
man, refined  and  courteous,  during  an  out- 
break of  drinking  he  likewise  sought  the  lowest 
company,  became  filthy  and  gross  in  his  habits, 
and  seemed  to  delight  in  all  things  vile.  He 
was  brought  to  me  during  one  of  his  attacks,  and 
on  recovering  was  so  humihated  to  think  that  he 
was  in  the  same  building  with  other  inebriates. 


112  MODERN  TREATMENT  OF  ALCOHOLISM 

that  he  refused  to  leave  his  room  for  two  weeks, 
and  had  all  his  meals  served  to  him  there,  and 
during  the  remainder  of  his  stay  would  associate 
only  with  myself  and  assistant.  On  leaving,  he 
begged  of  me  not  to  let  any  one  know  his  real 
name  or  position.  It  may  interest  my  readers  to 
learn  that  he  never  touched  stimulants  again,  and 
shortly  after  returning  home  he  wrote  me  a  most 
kind  letter  apologising  for  his  undue  pride  while 
with  me,  and  in  proof  of  the  sincere  change  in  him 
he  nobly  worked  amongst  the  fallen,  sending 
some  sixty  cases  for  treatment  as  a  result  of  these 
efforts.  The  third  case  was  that  of  a  son  of  a 
member  of  the  Upper  House  who  was  noted  for 
his  fastidiousness  regarding  dress,  his  perfect 
manners,  and  the  select  companions  with  whom 
he  associated.  Yet  I  saw  this  man  cuddling  a 
frowsy  tramp,  whose  filthy  face  he  repeatedly 
kissed.  After  the  attack  I  asked  him  how  it  was 
possible  for  one  so  particular  as  himself  to  act  so. 
He  indignantly  denied  that  the  thing  was  possible, 
and  when  I  referred  him  to  a  number  of  witnesses 
of  his  act  he  was  still  unconvinced,  and  maintained 
that  it  was  a  conspiracy  of  lies.  I  am  quite 
convinced  that  these  men  or  women  are  quite 
unconscious  of  their  surroundings  at  the  time,  or 
that  some  trick  of  memory  mercifully  obliterates 
all  traces  of  this  portion  of  their  lives.     When  we 


FORMS  OF  INEBRIETY  113 

know  of  these  extreme  cases  we  are  not  unprepared 
for  the  larger  numbers  of  less  horrifying  contrasts, 
but  even  in  the  mildest  cases  we  find  a  marked 
change  in  their  behaviour  to  those  about  them. 
These  cases  always  show  some  sign  of  the 
approaching  storm,  and  those  living  in  daily  con- 
tact with  them  soon  learn  to  know  when  to  expect 
an  outbreak.  The  appetite  falls  off,  signs  of 
restlessness  and  irritability  manifest  themselves, 
and  when  engaged  in  business  they  slacken  in 
attention  to  same.  Reahsing  their  danger,  many 
of  them  fight,  and  fight  hard,  to  avoid  the  in- 
evitable, until  their  resistance  wears  out  and  they 
are  swept  off  their  feet.  They  are  like  a  man 
who,  while  swimming  calmly  in  a  placid  stream, 
finds  himself  approaching  a  whirlpool ;  realising 
his  position,  he  struggles  to  avoid  the  danger,  but 
the  current  grows  stronger  each  minute,  while  his 
power  of  resistance  grows  less  with  his  struggles, 
and  shortly  he  is  swept  into  the  vortex,  to  be  later 
on  cast  ashore,  a  battered  wreck.  These  victims 
are  often  blamed  by  ignorant  friends  for  allowing 
themselves  to  be  overcome.  All  I  can  say  to 
these  thoughtless  judges  of  their  fellow-men  is, 
God  grant  that  they  may  never  have  to  undergo 
the  heroic  but  hopeless  struggles  of  those  whom 
they  so  little  understand  and  so  lightly  condemn. 

One  constantly  reads  of  heroic  struggles  in  other 
8 


114  MODERN  TREATMENT  OF  ALCOHOLISM 

conditions  of  life,  but  I  know  of  none  so  deserving 
of  our  admiration  as  the  struggles  of  a  strong  man 
against  this  periodic  demon.  I  well  remember 
witnessing  such  a  struggle  in  a  good-living  man 
possessed  of  an  iron  will,  and  I  shall  never  forget 
it.  No  doubt  the  victim  had  been  fighting  for 
days,  but  it  was  the  very  height  of  it  which  I  saw. 
He  was  pacing  the  floor  like  a  lion  newdy  caged, 
every  muscle  strained  to  its  utmost,  teeth  clenched 
rigidly,  and  hands  clasped  behind  with  the  nails 
cutting  into  the  flesh,  while  beads  of  perspiration 
stood  upon  his  brow.  Such  a  strain  would  soon 
wear  down  the  strongest  and  most  stubborn 
resistance.  This  heroic  struggle  would  be  worthy 
of  all  praise  if  there  was  a  chance  of  victory — how 
much  more  so  when  the  victim  knows  it  to  be 
hopeless,  yet  fights  to  the  very  death  from  a 
sheer  sense  of  duty  to  dear  ones.  I  feel  sure  that 
the  same  man  if  placed  in  some  trying  position 
in  battle  would  cover  himself  with  renown ; 
consequently  I  become  somewhat  impatient 
with  those  who,  knowing  nothing  of  such  heroism 
and  incapable  of  a  tithe  of  such  manliness,  preach 
to  such  from  their  lofty  pinnacle  of  self-righteous- 
ness. They  are  not  always  even  Pecksniffs  or 
other  forms  of  human  humbugs,  but  even  if 
honest  in  their  ignorance  it  would  be  better  if 
they  practised  charity  before  criticism.     I  have 


FORMS  OF  INEBRIETY  115 

emphasised  this  point  strongly  because  I  have 
known  many  cases  where  the  sufferer  has  been  so 
disheartened  by  the  constant  reproaches  of  a 
wife  or  friends  that  he  has  ceased  to  struggle 
further,  and  has  rapidly  sunk  into  a  hopeless 
condition.  That  I  believe  that  some  of  these  cases 
of  periodical  inebriety  have  no  memory  of  their 
drinking,  I  have  already  stated,  and  I  quote  the 
following  history  of  one  of  my  patients  in  support 
of  this  belief.  His  practice  was  to  suddenly 
disappear  from  his  business  and  engage  a  back 
bedroom  in  a  small  inn  in  a  low  quarter  of  the 
City.  Here  he  w^ould  lie  in  bed  drinking  bottle 
after  bottle  of  whisky  until  the  attack  wore  off. 
When  the  innkeeper  was  asked  why  he  supplied 
him,  he  replied  that  the  patient  was  apparently 
aware  of  all  he  was  doing,  would  talk  intelligently 
of  recent  events,  and  did  not  appear  to  get  very 
intoxicated,  and  consequently  he  saw  no  reason 
for  refusing  to  supply  him.  He  w^ould  read  the 
newspapers,  write  letters,  and  talk  coherently 
and  intelligently  with  any  of  the  inmates  of  the 
inn  who  cared  to  visit  him.  The  landlord's 
statements  were  corroborated  by  those  who  so 
visited  and  talked  with  him.  Yet  this  man 
assured  me  most  solemnly  that  from  the  moment 
of  his  leaving  his  business  until  his  attacks  ended 
he  remembered  absolutely  nothing,  nor  was  he  ever 


ii6  MODERN  TREATMENT  OF  ALCOHOLISM 

able  to  recall  one  single  incident  of  these  periods. 
The  last  attack  he  had  before  taking  treatment  at 
my  sanatorium  was  commenced  as  follows  :  He 
was  keenly  interested  in  a  business  scheme  which 
necessitated  daily  interviews  with  his  solicitor, 
who  informed  me  that  up  to  the  very  moment  of 
his  disappearance  he  showed  no  signs  of  the 
approaching  attack.  They  were  as  usual  dis- 
cussing the  details  of  the  scheme  when  the  patient 
said,  "  Kindly  excuse  me  for  five  minutes.  I 
must  see  a  man  a  few  doors  away  ;  I  will  return 
in  a  few  minutes."  He  did  not  return,  and  was 
not  found  for  three  weeks.  He  had  meantime 
gone  straight  away  to  an  inn,  as  in  previous 
attacks.  The  attack  here  would  appear  to  be 
devoid  of  premonitory  symptoms,  but  I  am  of  the 
opinion  that  they  were  present,  but  were  con- 
cealed from  the  eyes  of  the  unsuspecting  sohcitor 
by  the  patient's  excited  interest  in  the  scheme, 
for  his  wife  had  noticed  the  usual  change.  My 
faith  in  the  man's  statement  that  he  was  oblivious 
to  all  that  passed  during  the  period  which  elapsed 
between  the  time  he  left  the  solicitor  and  his 
rescue  by  a  friend  was  strengthened  by  his 
behaviour  while  at  the  sanatormm.  He  arrived 
quite  sober,  and  during  his  first  interview  with  me 
asked  if  there  was  anything  he  could  do  to  help 
the    treatment    beyond    the    usual    instructions 


FORMS  OF  INEBRIETY  117 

which  I  had  given  him.     I  said,  "  Don't  smoke 
too  much." 

"  I  won't  smoke  a  single  pipe  while  here." 
"  Don't  go  into  the  town  during  the  first  week." 
"  I  won't  leave  the  grounds  while  here." 
"  Rest  the  first  week,  then  take  all  the  exercise 
out  of  doors  you  can,  short  of  fatigue." 

He  said,  ''  Trust  me,  doctor,  to  faithfully  carry 
out  all  your  instructions,  for  I  must  get  cured." 

He,  although  a  heavy  smoker,  never  touched 
tobacco,  never  left  the  grounds,  and  faithfully 
did  all  he  promised  during  the  six  weeks  of  his 
stay.  One  day,  when  something  unusual  was 
attracting  the  other  patients  to  the  harbour, 
he  was  exercising  in  the  grounds,  and  I  said,  "  Why 
don't  you  go  with  the  rest  and  see  the  boat  races  ?  " 
"  No,  doctor ;  this  is  a  hfe-and-death  affair  with 
me,  and  I  am  determined  to  do  my  utmost  to 
get  cured."     He  succeeded. 

I  am  further  strengthened  in  my  belief  that 
memory  of  these  periods  may  be  entirely  obliter- 
ated in  some  by  two  cases  in  the  sanatorium.  One 
was  commencing  an  attack  on  arrival,  but  on 
the  next  day  the  treatment  had  made  it  impossible 
to  keep  any  whisky  on  his  stomach,  yet  he  per- 
sistently asked  for  it.  Now  I  have  always  made 
it  a  rule  to  give  a  patient  a  drink  if  he  wants 
it,  because  no  treatment  can  be  effective  if  the 


ii8  MODERN  TREATMENT  OF  ALCOHOLISM 

slightest  desire  for  stimulants  remains.  I 
ordered  the  attendant  to  see  that  he  had  a  drink 
as  often  as  he  wished  for  it,  fully  expecting  that 
when  he  found  he  could  not  drink  it  he  would 
desist,  but  in  this  I  was  mistaken ;  and  when  I 
asked  him  why  he  persisted  seeing  that  even 
the  odour  of  it  made  him  vomit,  he  replied,  "  I 
am  determined  to  make  it  stay  down."  This 
went  on  for  a  week,  during  which  time  I  often  sat 
at  his  bedside  conversing  with  him  on  all  sorts 
of  subjects,  and  finding  nothing  abnormal  about 
his  conversation.  I  was  puzzled  at  his  per- 
sistency regarding  the  drink.  At  the  end  of  the 
week  he  appeared  one  morning  at  breakfast, 
and  when  treating  him  I  said,  "  Well,  have  you 
given  up  the  attempt  to  swallow  that  glass  of 
whisky?"  He  stared  at  me  in  astonishment, 
asking,  "What  drink?"  I  related  the  week's 
experience.  "  But  how  can  that  be,  doctor, 
seeing  I  only  arrived  here  last  night  ?  "  "  You 
mean  a  week  last  night,"  I  said;  and  although 
he  knew  perfectly  the  date  of  his  entry  he  insisted 
that  he  had  not  been  twenty-four  hours  with  me. 
I  had  to  produce  the  daily  papers  to  convince 
him,  and  then  he  was  not  satisfied  until  every 
patient  in  the  place  had  corroborated  the  date 
and  the  fact  that  he  had  spent  a  week  in  bed. 
He  assured  me  that  he  was  never  more  astonished 


FORMS  OF  INEBRIETY  119 

in  his  life  when  he  was  obhged  to  beUeve  our 
statements.  He  apparently  remembered  nothing 
of  the  whole  week.  I  had  another  similar  case 
to  the  above,  differing  only  in  minor  details. 

There  is  nothing  during  this  period  in  the 
appearance  or  conversation  to  indicate  that  these 
men  do  not  know  what  they  are  doing  and  talking 
about,  and  I  am  prepared  to  believe  that  they 
do  so  at  the  time  but  have  all  memory  of  it 
obliterated  at  the  moment  of  recovery.  This 
being  admitted,  one  is  prepared  to  find  partial 
lapses  of  memory  in  minor  cases  which  would 
account  largely  for  many  apparently  contra- 
dictory facts  occurring  during  these  attacks. 

Another  peculiar  feature  of  these  periodical 
cases  is  the  curious  delusion  the  patient  has 
regarding  his  cessation  from  drink  wlien  the 
attack  has  ceased.  He  invariably  informs  those 
attending  him  that  he  has  decided  to  stop  drink- 
ing and  reform,  and  quite  beheves  that  his 
resolution  is  alone  responsible  for  the  refusal 
of  further  stimulants.  As  a  matter  of  fact, 
his  resolution  plays  a  very  small  part  in  most 
cases.  He  has  done  two  things  by  his  indulgence, 
namely,  saturated  his  system  with  alcohol,  and  in- 
flamed his  stomach  to  such  a  degree  that  he  is 
nauseated  on  any  further  attempt  to  drink. 
These  are  two  very  potent  factors  in  the  case. 


120  MODERN  TREATMENT  OF  ALCOHOLISM 

His  craving  has  ceased  and  all  alcoholic  beverages 
have  become  repugnant  to  him  ;  consequently, 
having  lost  all  desire  for  it  and  finding  himself 
unable  to  take  it,  he  arrogates  to  himself  the 
virtuous  resolve  to  reform.  That  he  really 
believes  that  to  him  belongs  all  the  credit  of  the 
resolve  to  reform,  I  am  quite  prepared  to  accept  ; 
at  the  same  time,  to  offended  nature  belongs  the 
credit,  if  an}^  exists. 

Before  leaving  this  class,  I  will  mention  a 
question  which  is  often  put  to  the  medical 
attendant,  namely,  Why  is  it  that  the  periodical 
inebriate  is  so  free  from  all  craving,  which  in 
some  cases  amounts  to  an  actual  disgust  for 
alcohol,  during  the  intervals  of  his  attacks  ?  One 
can  only  theorise,  and  all  theories  are  unsatis- 
factory, but  here,  as  in  other  well-known  diseases, 
one  is  obliged  to,  until  more  perfect  knowledge 
of  the  subject  gives  us  the  real  cause.  The 
theory  which  I  have  formed,  and  which  I  give 
for  what  it  is  worth,  is  this,  that  in  some  alcohol 
is  capable  of  being  stored  up  in  the  system, 
possibly  in  some  allotropic  form  or  chemical 
combination  during  the  attack,  that  this  form 
or  combination  gradually  breaks  down  during 
the  interval  in  sufficient  quantity  to  satisf}^  the 
weakened  craving  for  it,  and  upon  its  exhaustion 
the  symptoms  of  a  fresh  attack  appear,  and  the 


FORMS  OF  INEBRIETY  121 

process  is  repeated.  I  frankly  admit  that  there 
is  no  proof  of  any  real  value  in  support  of  this 
theory,  but  it  accounts  for  some  of  the  special 
features  of  periodical  drinkers  as  nothing  else, 
so  far  as  I  know,  does.  It  has  its  weak  points, 
undoubtedly  ;  so  have  many  other  readily 
accepted  theories  in  pathology.  In  support  of  it 
one  might  refer  to  the  well-known  fact  that  the 
human  system  stores  up  other  forms  of  food,  and 
gradually  breaks  them  down  to  meet  the  needs 
of  the  body,  as,  for  instance,  fat  and  glycogen ; 
that  some  substances  are  known  to  assume 
allotropic  forms  under  certain  conditions,  and 
that  our  knowledge  of  the  chemistry  of  the 
organism  is  not  yet  so  perfectly  understood  as  to 
enable  us  to  say  that  alcohol  may  not  do  the 
same.  It  would  account  for  the  absence  of  a 
craving  for  alcohol  during  the  intervals.  And 
lastly,  it  is  a  well-known  fact  that  any  unusual 
strain  upon  the  vital  forces  during  the  interval 
lessens  that  interval;  and  it  may  well  be  that 
owing  to  the  strain  the  supply  is  more  rapidly 
exhausted  in  a  similar  way  that  a  man  loses  some 
of  his  stored  fat  during  such  a  strain.  The 
theory  would  also  help  to  explain  why  these 
periods  regularly  get  shorter  and  shorter,  by 
assuming  that  the  power  to  store  the  excess  of 
alcohol  lessens  with  time,   or  that  the  demand 


122  MODERN  TREATMENT  OF  ALCOHOLISM 

increases,  or  possibly  both  play  a  part.  The 
theory  put  forward  by  some  that  it  is  a  temporary 
insanity,  I  am  not  able  to  accept  in  view  of  the 
facts.  I  leave  that  for  a  quite  different  class  of 
inebriety,  which  I  will  describe  later  on. 

Leaving  the  theory  alone,  let  us  return  to 
facts.  The  periodical  drinker  commences  with 
short  attacks  and  long  intervals,  but  the  almost 
invariable  rule  is  for  the  attacks  to  increase  in 
length  or  severity  and  the  intervals  to  shorten, 
till  from  one  attack  every  six  or  twelve  months 
they  become  more  numerous  yearly,  until  they 
practically  verge  into  steady  drinking.  Some 
take  longer,  some  shorter  time,  but  whatever  the 
rate  of  progress,  the  result  is  the  same  in  most  cases ; 
and  although  the  patient  may  not  actually  drink 
daily,  he  finds  a  time,  if  he  survives  long  enough, 
when,  like  the  chronic  inebriate,  his  craving  is 
always  present  if  not  satisfied.  I  have  heard  men 
boast  that  they  only  go  on  the  drink  once  or  twice  a 
year.  To  all  such  I  would  say.  Fight  it  while  you 
may,  lest  a  day  comes  when  you  will  find  that  the 
once  a  year  becomes  four  or  five  times  a  year. 

The  Dipsomaniac 

The  term  dipsomaniac  is  often  loosely  applied 
to  any  form  of  excessive  drinking,  but  I  think 


FORMS  OF  INEBRIETY  123 

it  would  be  better  to  limit  its  use  to  those  cases 
when  outbreaks  are  marked  by  mental  excitement 
of  a  maniacal  kind.  If  we  do  this  I  am  convinced 
we  shall  find  less  confusion  in  our  classification 
than  by  the  present  use  of  the  term.  We  will 
also  find  this  class  is  distinctive  in  its  leading 
characteristics  from  the  others.  I  do  not  see 
that  much  is  to  be  gained  by  subdividing  the 
class  into  further  divisions,  such  as  pseudo- 
dipsomaniac,  etc.  The  simpler  the  clasification 
of  inebriates  the  better,  for  if  w^e  give  way  to  this 
tendency  we  will  soon  find  a  hopeless  list  of  con- 
fusing terms  which  neither  aids  our  treatment 
nor  our  understanding  of  the  disease.  A  few 
years  ago  it  was  the  aim  of  every  dermatologist 
to  add  a  new  name  to  the  already  confusing  Hst 
of  skin  diseases,  with  the  result  of  making  the 
confusion  worse  confounded  and  the  treatment 
more  difficult  ;  so  much  so,  indeed,  that  in  very 
defence  of  the  science  leading  dermatologists 
were  compelled  to  simplify  the  list.  If  we  give 
way  to  that  sort  of  thing  w^e  shall  have  divisions 
without  number,  and  this  will  be  followed  by  an 
effort  to  fit  a  certain  remedy  to  each  division, 
which  will  hopelessly  confuse  matters.  I  am 
therefore  convinced  that  the  simpler  the  clasifica- 
tion the  better,  providing  we  cover  all  cases. 
The   wiser   course   would   be   to   limit    the  term 


124  MODERN  TREATMENT  OF  ALCOHOLISM 

dipsomaniac  to  those  cases  which  are  devoid  of  a 
craving  for  alcohol  during  the  interval  between 
the  attacks,  and  are  marked  by  a  pronounced 
mania  during  attacks. 

Under  the  above  definition  the  number  of 
cases  of  dipsomania  form  but  a  small  proportion 
of  inebriates,  but  the  most  dangerous  and  difficult 
ones  to  treat.  With  regard  to  the  latter  I  shall 
speak  later  on,  but  I  would  like  to  utter  a  word 
of  warning  here  about  the  danger  to  those  who 
come  in  contact  with  these  cases.  The  mania 
may  take  a  suicidal  or  homicidal  turn,  and  it 
may  come  at  a  moment  when  least  expected  ; 
therefore  none  of  these  cases  should  be  left 
in  charge  of  friends  or  ordinary  nurses,  but  fully 
trained  and  experienced  attendants  should  always 
be  provided.  On  three  separate  occasions  I 
came  within  an  ace  of  losing  my  life  at  the  hands 
of  a  dipsomaniac  patient.  On  one  of  these  the 
patient  was  noisy  and  excited,  but  had  not  shown 
any  signs  of  danger  to  those  about  him.  While 
one  attendant  was  busy  placing  extra  protection 
to  the  window,  the  other  stepped  into  an  adjoining 
room  to  get  the  patient's  medicine.  I  had  just 
turned  to  leave  the  room,  when  the  patient 
silently  left  his  bed,  ghded  swiftly  across  the 
room,  seized  the  hatchet  which  the  attendant 
had  laid  aside  for  the  moment,  and  was  on  the 


FORMS  OF  INEBRIETY  125 

point  of  braining  me  from  behind  when  the 
returning  attendant  shouted  a  warning.  The 
point  I  would  hke  to  emphasise  is  this — two  trained 
and  experienced  attendants  were  in  charge  when, 
without  any  warning  whatever,  and  within  a 
single  moment,  I  would  have  lost  my  life,  if  the 
second  attendant  had  returned  an  instant  later. 
On  both  the  other  occasions  the  impulse  was  just 
as  sudden  and  the  escape  as  miraculous.  When 
one  thinks  that  such  patients  are  often  placed 
in  charge  of  a  young  female  nurse  or  a  friend  or 
relative,  one  feels  justified  in  emphasising  the 
warning  as  to  the  danger. 

Whatever  may  constitute  a  dipsomaniac,  I 
cannot  help  coming  to  the  conclusion  that  every 
dipsomaniac  is  insane,  but  the  insanity  is  not 
sufficiently  marked  during  the  intervals  to  attract 
attention,  and  is  only  apparent  when  the  patient 
is  excited  by  alcohol.  If  these  patients  are 
carefully  studied  during  their  periods  of  sobriety, 
they  all  show  some  marked  peculiarities  of 
character,  but  which  are  not  sufficient  to  differen- 
tiate them  from  a  large  class  of  persons  who  are 
not  considered  insane.  I  was  once  asked  by  the 
wife  of  a  dipsomaniac  if  her  husband  was  insane. 
I  asked  if  he  had  been  drinkmg  again  ;  she  said 
"No,"  but  he  compelled  her  to  do  the  most 
abominable    and    unnatural    things    in    private, 


126  MODERN  TREATMENT  OF  ALCOHOLISM 

and  she  felt  sure  he  must  be  insane.  Now  I 
studied  this  case  for  some  time  without  finding 
any  very  marked  pecuharities  of  character,  as 
he  cunningly  covered  up  all  traces  of  his  in- 
sanity from  outsiders.  He  finally  committed 
suicide,  and  I  subsequently  ascertained  that  his 
father  had  died  in  a  lunatic  asylum.  It  is  very 
difficult  to  obtain  a  clear  history  of  these  patients, 
as  the  friends  naturally  desire  to  conceal  all 
traces  of  insanity  in  the  family,  but  I  am  con- 
vinced that  if  a  full  history  were  obtained  in  all 
cases  we  should  find  evidence  of  hereditary  in- 
sanity in  the  great  majority  of  patients.  There- 
fore these  patients  are  a  distinct  class,  and 
require  different  treatment  from  all  others. 

Voluntary  Drinkers 

The  fourth  class  of  inebriates  are,  strictly 
speaking,  not  medical  cases  at  all.  They  are  the 
voluntary  drinkers,  and  for  a  certain  period  in 
their  lives  are  not  afflicted  by  any  craving  for 
alcohol.  In  the  beginning  it  is  not  the  physical 
but  the  moral  side  of  them  which  is  at  fault. 
Nevertheless,  as  they  often  eventually  become 
inebriates,  it  is  necessary  to  consider  them  from 
a  medical  point  of  view. 

The  distinguishing  point   about  them  is  that 


FORMS  OF  INEBRIETY  127 

they  have  no  physical  craving  for  alcohol,  and 
drink  from  mere  caprice.  If  asked  to  join  a 
drinking  party  they  will  do  so,  and  become  in- 
toxicated for  the  mere  fun  of  the  thing.  They 
drink  in  order  to  get  drunk  either  for  the  pleasure 
it  gives  them  or  to  forget  their  trouble  and 
sorrow,  and  when  the  occasion  passes  which 
caused  them  to  drink  they  sober  up  entirely 
free  from  any  physical  craving,  and  will  not 
drink  again  until  some  special  circumstance 
induces  them  to  do  so.  They  can  be  drunk  or 
sober  at  will,  provided  they  have  the  means  to 
pay  for  it.  Their  drinking  is  a  mere  vice,  and  it 
is  the  confusion  of  this  class  of  drinkers  with 
the  genuine  inebriates  that  has  caused  so  much 
misunderstanding  of  the  whole  question.  It  is 
necessary  to  make  this  point  quite  clear,  namely, 
that  there  are  two  classes  of  drinkers — those 
who  get  drunk  from  mere  vice,  and  those  who  do 
so  from  a  need  to  satisfy  a  physical  craving. 
Let  this  be  clearly  understood,  and  the  great 
controversy  which  has  raged  for  ages  and  which 
is  still  raging  will  cease,  and  the  preacher,  the 
temperance  lecturer,  the  social  reformer,  and  the 
laity  generally  will  cease  to  hold  diverging  views, 
while  the  genuine  inebriate  will  get  more  con- 
sideration and  suffer  less  undeserved  persecution 
by   the   self-righteous,   uncharitable   critics   who 


128  MODERN  TREATMENT  OF  ALCOHOLISM 

pass  judgment  upon  them,  in  their  ignorance. 
The  whole  ground  of  treatment  would  also  be 
placed  upon  a  clear  and  rational  basis.  Millions 
of  money  which  is  now  wasted  in  misguided  efforts 
would  be  spent  in  a  useful  direction.  It  is  only 
fair  to  add  that  the  laity  are  not  altogether  to 
blame  in  this  matter,  for  until  recently  only  a 
small  proportion  of  the  medical  profession  under- 
stood the  true  nature  of  inebriety  ;  indeed,  one 
can  go  further,  and  say  that  even  to-day  doctors 
are  to  be  found  who  are  still  ignorant  concerning 
this  question,  and  consequently  are  misleading 
the  laity.  Magistrates,  from  their  large  experi- 
ence of  such  cases,  are  far  better  informed  upon 
the  subject  than  many  of  our  profession.  Every 
specialist  in  inebriety  knows  that  immeasurable 
mjsery  and  harm  has  been  done,  and  is  being 
done,  through  the  misunderstanding  of  the  facts. 
When  w^e  come  to  consider  the  question  of  treat- 
ment, I  will  show  how  this  misunderstanding 
works  a  further  immeasurable  harm. 

Drug  Inebriety 

We  now  come  to  the  consideration  of  the 
question  of  inebriety  caused  by  other  forms  of 
drugs  than  alcohol.  This  comprises  a  long  hst, 
but  the  most  important  is  opium,  or  some  of  its 


FORMS  OF  INEBRIETY  129 

derivatives   or   preparations,   namely,   morphine, 
laudanum,  paregoric,  heroin.     These  differ  con- 
siderably in  their  effect  upon  the  system,  and  to 
understand   them   one   is   obliged   to   study   the 
effects   of  each   form   of  the   drug.     The   opium 
eater  or  smoker  is  as  common   in   the   East  as 
the  alcohol  inebriate  in  the   West,   and  it  is  a 
well-known  fact  that  the  effect  of  opium-smoking 
in  the  East  is  as  different  as  possible   from  its 
effect  in  the  West  ;   that  is,  generally  speaking, 
of  course,  for  there  are  exceptions  to  this  rule 
as  to  all  others.     I  think  it  is  Sir  Lauder  Brunt  on 
who  mentions  in  his  excellent  book  The  Action 
of  Medicines  the  following  :   *'  The  Oriental  uses 
opium  in  much  the  same  way  as  we  use  alcohol," 
and  goes  on  to  say  that,  "  If  we  transport  the 
Oriental    to    the    West    and    substitute    alcohol 
for    opium,   he    goes    all    to    pieces.      Similarly, 
if  we  reverse  the  action  and  send  the  Westerner 
to    the    East,    substituting    opium    for    alcohol, 
he  likewise  goes  all  to  pieces.     Yet  each  in  his 
own   land   may   be   what   we   term   a   moderate 
smoker  (or  drinker)  respectively."     This  is  prob- 
ably due  to  a  certain  tolerance  acquired  through 
generations    of    users    in    each    case.     However 
this  may  be,  the  fact  remains  that  the  two  drugs 
have    entirely    different    effects    upon    different 
races.     The    opium -smoker    in    the    East    may 
9 


130  MODERN  TREATMENT  OF  ALCOHOLISM 

smoke  his  opium  for  years  with  as  Uttle  harm  as 
the  moderate  drinker  here  may  receive  from  his 
alcohoL  I  do  not  mean  to  say  that  all  opium- 
smokers  can  do  so,  but  a  large  proportion  do, 
while  the  remainder  go  to  pieces  just  as  a  certain 
proportion  of  moderate  users  of  alcohol  do  in 
this  country. 

Let  us  now  consider  the  effect  upon  Westerners 
who  use  opium  as  opium.  The  habit  may  be 
contracted  quite  innocently,  or  it  may  be  deliber- 
ately acquired  ;  generally  the  latter.  A  patient 
of  mine,  a  medical  man,  contracted  the  habit 
through  taking  laudanum  for  diarrhoea ;  another, 
through  a  nurse  administering  paregoric  to  relieve 
abdominal  pains ;  another,  through  the  taking 
of  opium  pills  prescribed  b}/  her  doctor  ;  others 
from  various  similar  reasons.  They  all  found 
the  effect  fascinating ;  they  ate  better,  slept 
sounder,  were  freed  from  their  aches  and  pains  ; 
their  worries  vanished,  and  life  took  on  a  roseate 
hue  which  was  very  enjoyable.  But  later  on  a 
change  came  over  tlie  scene.  The  drug  ceased 
to  produce  these  pleasant  sensations,  and  a  train 
of  symptoms  set  in  quite  the  reverse  of  those 
which  I  have  mentioned.  To  meet  these  they 
took  increasing  quantities  of  the  drug,  until  a 
time  arrived  when  even  these  large  doses  merely 
sufficed  to  temporarily  abate  their  great  misery ; 


FORMS  OF  INEBRIETY  131 

and  if  from  any  cause  the  supply  failed  they 
suffered  excruciating  pains  and  distress,  while 
their  bodily  health  steadily  declined.  Their 
moral  decay  is  very  striking.  They  will  lie  and 
steal  in  the  most  unblushing  way.  They  also 
become  very  cunning  in  their  efforts  to  obtain  or 
secrete  their  supply  of  the  drug  or  in  order  to 
cover  up  their  failing.  It  is  often  this  very  lapse 
of  morals  which  first  directs  the  attention  of  their 
friends  to  the  habit,  for  they  invariably  use  every 
means  known  to  them  to  pre\Tnt  their  friends 
knowing  of  their  weakness.  In  this  they  may  be 
successful  for  some  time  at  first,  provided  they 
are  not  under  the  eye  of  some  one  accustomed 
to  such  cases  ;  but  sooner  or  later  the  exposure 
must  come,  and  the  hideous  truth  is  flashed  upon 
their  friends,  and  the  struggle  for  reclamation 
follows. 

But  opium  users  in  this  part  of  the  world  are 
few  in  comparison  to  those  who  are  victims  of 
the  morphine  habit,  and  it  is  this  latter  form  which 
the  medical  man  usually  meets  with.  Here  we 
have  to  deal  with  a  more  intractable  form  of 
disease.  All  that  has  been  said  of  the  opium 
taker  is  true  of  the  morphine  user,  but  in  a  greatly 
exaggerated  degree.  Morphine  is  an  alkaloid 
of  opium,  but  the  latter  contains  other  alkaloids 
which  have  a  modifying  effect.     Again,  opium  is 


132  MODERN  TREATMENT  OF  ALCOHOLISM 

swallowed   and   is   absorbed    from    the   stomach 
slowly,    while    morphine    is    generally    injected 
directly  into  the  tissues  and  quickly  absorbed  by 
the  circulation,  and  its  effect  is  rapid  and  intense. 
These  two  factors  seem  to  me  to  account  for  the 
difference   to  the  users  of  the  two  drugs.     The 
opium  taker  is  much  easier  to  control  and  de- 
cidedly much  the  easier  to  treat  of  the  two.     The 
morphine  habit  is  much  more  readily  acquired 
than  the  opium  habit.     This  is  no  doubt  due  to 
its  rapid  and  intense  action  when  injected,  and  its 
rapid  absorption  when  tabloids  are  placed  in  the 
mouth.     The  morphine  fiend  no  longer  requires 
a  syringe,  for  he  has  discovered  that  the  placing 
of  a  tabloid  of  the  drug  under  the  tongue  will 
answer  nearly  as  well  owing  to  its  rapid  absorp- 
tion.    Wliile  no  one  acquires  the  habit  of  taking 
opium  rapidly,  cases  are  on  record  of  the  very 
rapid  acquisition  of  the  morphine  habit,  and  I 
have  seen  one  case  where  all  the  evidence  points 
to  the  astonishing  fact  that  the  habit  was  estab- 
lished by  the  first  injection  of  morphine.     I  may 
say    that    I    sifted    the    evidence    given   by    the 
friends  most  carefully,   inquiring  minutely  into 
the  previous  history  of  the  patient,  but  elucidating 
no  evidence  of  an  earlier  use  of  the  drug  ;   in  fact, 
the  whole  evidence  was  directly  opposed  to  the 
possibility  of  any  knowledge  or  use  of  the  drug 


FORMS  OF  INEBRIETY  133 

prior  to  the  injection  mentioned.  This  is  a  very 
important  matter  from  a  medical  point  of  view, 
warning  the  physician  that  in  the  use  of  this 
most  useful  remedy  he  cannot  exercise  too  much 
caution.  The  known  practice  of  allowing  the 
nurse  to  administer  the  drug  is  extremely  danger- 
ous in  many  cases,  and  should  only  be  permitted 
where  it  is  impossible  for  the  medical  attendant 
to  do  so  himself.  If  one  injection  of  the  drug 
is  sufficient  to  set  up  a  craving  in  one  individual, 
it  follows  that  two,  three,  or  four  injections  may 
develop  the  craving  in  others ;  and  as  the 
physician  cannot  possibly  know  beforehand  what 
the  effect  of  the  drug  will  be  in  any  individual 
case,  the  need  for  caution  in  each  case  is  evident. 
If  I  have  laboured  this  point  somewhat,  it  is 
owing  to  my  having  seen  so  many  cases  of  the 
morphine  habit  due  entirely  to  the  carelessness  of 
the  physician  in  administering  the  drug.  If  the 
case  of  the  opium  taker  is  bad,  that  of  the  morphine 
user  is  still  worse,  for  the  suffering  of  the  latter  is 
greatly  intensified.  What  this  suffering  is  may  be 
inferred  from  the  great  precautions  taken  by  the 
victim  in  order  to  prevent  a  failure  in  his  supply 
of  the  drug,  and  the  cunning  displayed  in  secret- 
ing the  same.  This  is  best  illustrated  by  a  few 
instances  occurring  in  my  own  patients. 

A  medical  man  brought  his  wife   to  me   for 


134  MODERN  TREATMENT  OF  ALCOHOLISM 

treatment  for  the  morphine  habit.  He  assured 
me  that  his  wife  had  not  brought  any  of  the  drug 
with  her.  I  asked  him  if  he  had  carefully  ex- 
amined her  since  her  arrival.  He  replied  that 
he  had,  and  was  still  confident  that  she  had  none 
of  the  drug.  I  then  made  a  personal  examination, 
and,  having  satisfied  myself  that  none  of  the  drug 
was  concealed  in  the  usual  places,  such  as  the 
hair,  undergarments,  etc.  etc.,  I  noticed  the 
patient  was  wearing  a  fur  coat.  As  these  coats 
are  always  padded,  it  suggested  a  possible  hiding- 
place.  I  therefore  placed  the  coat  flat  upon  a 
table  and  passed  my  hands  carefully  over  it, 
pressing  each  part  between  the  hand  and  the  table. 
I  was  rewarded  by  finding  a  dozen  tubes  of 
morphine  tabloids  carefully  concealed  in  the 
wadding  of  the  coat,  the  seams  having  been 
opened  and  then  sewn  up  again.  Another  case 
was  that  of  a  doctor,  who,  having  assured  me 
that  he  had  come  with  a  firm  determination 
to  get  rid  of  his  failing,  and  who  dehvered  into 
my  care  a  supply  of  the  drug  and  two  syringes,  so 
far  convinced  me  of  his  sincerity  that  I  omitted 
a  personal  examination,  but,  knowing  how  un- 
reliable all  such  cases  are,  I  decided  to  carefully 
note  every  symptom.  During  the  first  twenty- 
four  hours  I  was  convinced  that  he  was  taking 
more   of  the  drug  than   I  was  allowing  him  to 


FORMS  OF  INEBRIETY  135 

have.  Having  convinced  myself  of  this,  I  watched 
most  carefuUy,  but  failed  for  several  days  to 
discover  any  source  of  supply.  A  very  slight 
incident  directed  my  attention  to  the  method  used 
in  this  case.  Being  required  to  write  a  short  note, 
he  asked  permission  to  take  it  to  his  room  for  the 
purpose,  as  he  preferred  using  his  own  fountain 
pen  to  any  other,  although  there  were  several 
varieties  of  pens  upon  the  desk  at  his  disposal. 
This  aroused  my  curiosity,  and  I  decided  to 
investigate  the  question  of  that  particular  pen 
on  the  first  occasion.  It  turned  out  to  be,  as  I  had 
suspected,  a  complete  syringe  and  reservoir  for 
morphine  tabloids.  This  being  removed,  his 
further  supply  ceased.  Another  case  was  one 
which  puzzled  me  for  a  long  time  as  to  the  source 
of  supply.  I  had  carefully  searched  every  inch 
of  clothing  and  room  without  coming  across 
it,  and  it  was  only  by  accident  that  it  was  dis- 
covered, although  I  knew  the  patient  to  be  taking 
more  than  I  allowed.  I  was  standing  in  the 
garden  concealed  by  some  shrubbery  when  I 
heard  a  window  open,  and,  looking  to  see  what  it 
meant,  I  was  surprised  by  noting  a  hand  carefully 
pass  out  of  the  only  partially  opened  window  and 
feel  about  underneath  the  window-sill.  As  I 
knew  that  this  room  belonged  to  a  morphine 
patient,  T  at  once  suspected  what  it  meant,  and  I 


136  MODERN  TREATMENT  OF  ALCOHOLISM 

found  there  a  cunningly  secreted  syringe  and 
supply  of  the  drug.  Another  case  baffled  me 
altogether,  as  some  will  do,  no  matter  how  great 
one's  experience  may  be.  Knowing  this  patient 
to  be  using  more  than  the  allowance  of  the  drug, 
and  failing  utterly  to  get  any  trace  of  his  source 
of  supply,  I  refused  to  treat  him  further.  The 
patient  then  volunteered  to  show  me  how  he  had 
hidden  his  supply  of  the  drug.  He  had  brought 
with  him  a  syringe  and  a  quantity  of  the  drug 
made  into  a  concentrated  solution.  This  he 
carefully  sprayed  on  the  wall  of  his  room  and 
allowed  to  dry.  The  colour  was  exactly  that 
of  the  wall.  When  he  wished  for  a  dose  of  the 
drug  he  merely  scraped  a  sufficient  quantity 
from  the  wall  and  used  it. 

But  necessary  as  it  is  to  discover  their  hidden 
source  of  supply,  it  is  more  important  to  be  able 
to  tell  when  patients  are  taking  the  drug  in 
addition  to  the  allowance  made  them,  and  when 
we  discuss  the  treatment  I  will  describe  a  simple 
method  by  which  one  can  always  tell  when  they 
are  doing  so. 

There  is  another  derivative  of  opium  which  has 
lately  come  into  use,  and  which  is  a  more  dangerous 
drug  than  morphine,  although  it  is  generally 
believed  to  be  much  less  so  ;  I  refer  to  Heroin. 
It  is  chiefly  used  in  cough  mixtures  as  a  sedative. 


FORMS  OF  INEBRIETY  137 

I  think  the  most  pitiful  case  of  drug-taking  I  ever 
saw  was  that  of  a  user  of  this  drug.  He  was 
travelHng  in  New  Zealand,  and,  being  about  to  go 
into  the  hills  where  he  would  be  unable  to  obtain 
his  usual  supply  of  morphine,  he  applied  to  a 
local  medical  man  to  ask  his  advice.  Apparently 
not  knowing  the  dangerous  nature  of  heroin,  the 
doctor  gave  him  a  supply  of  this  drug,  with 
instructions  how  to  use  it,  telling  him  that  it 
would  be  much  less  harmful  than  the  morphine, 
and  would  completely  take  its  place.  On  return- 
ing to  civilisation  some  weeks  later,  he  attempted 
to  return  to  the  use  of  morphine,  but  found  that 
it  would  not  replace  the  heroin,  and  he  was  com- 
pelled to  continue  using  this  drug.  When  he 
came  to  the  Norwood  Sanatorium  for  treatment  he 
was  in  a  pitiful  condition.  His  mental  faculties 
were  apparently  unaffected,  but  he  was  unable 
to  walk  without  the  aid  of  two  sticks  and  then 
only  with  the  greatest  of  difficulty,  a  slow, 
dragging,  semi-paralysed  step.  He  looked  like 
a  man  who  was  suffering  from  some  spinal  com- 
plaint. If  the  quantity  of  drug  was  reduced 
below  a  certain  point  his  sufferings  were  intense, 
and  nothing  could  be  found  that  would  relieve 
them,  excepting  the  heroin  itself.  During  my 
experience  in  the  treatment  of  such  cases  of 
drug-taking  I  witnessed  some  very  piteous  sights, 


138  MODERN  TREATMENT  OF  ALCOHOLISM 

but  never  in  my  life  have  I  come  across  anything 
to  compare  with  the  condition  of  this  unfortunate 
man.  He  was  intensely  anxious  to  be  relieved  of 
the  curse  of  this  drug,  but  the  ordinary  treatment 
for  morphine  failed  utterly  to  give  him  any  relief, 
and  I  was  unable  to  find  anything  that  would 
satisfactorily  lessen  the  use  of  the  drug.  At  the 
time  I  was  not  aware  of  the  virtues  of  combretum 
sundriacum.  He  only  remained  some  ten  or 
twelve  days,  and  ever  since  I  have  known  of  the 
virtues  of  the  Chinese  herb  I  have  wished  for  an 
opportunity  of  testing  it  in  these  cases,  as  I  believe 
it  would  be  decidedly  helpful  in  treating  them. 

People  who  take  sedative  cough  mixtures 
containing  this  drug  run  far  more  risk  of  con- 
tracting the  habit  than  they  are  aware  of.  I  had 
a  personal  experience  of  this  two  years  ago  when 
on  a  holiday  in  Cornwall.  1  had  taken  a  supply 
of  a  preparation  of  this  nature,  as  at  the  time  I 
had  an  attack  of  chronic  bronchitis,  the  cough 
of  which  was  very  troublesome  and  prevented 
my  proper  rest.  I  found  a  dose  or  two  of  the 
mixture  on  retiring  gave  me  a  fairly  good  night's 
rest.  Contracting  a  slight  cold,  the  cough  be- 
came very  much  worse,  and  that  evening  I  was 
compelled  to  take  several  doses  of  the  mixture 
in  order  to  relieve  it.  The  next  day  I  felt  strangely 
elated — felt   as  if  years  of  age   had  been  with- 


FORMS  OF  INEBRIETY  139 

drawn.  I  can  only  compare  the  feeling  with 
that  of  a  man  of  fifty  years  of  age  suddenly  finding 
himself  back  to  youthfulness.  All  the  distressing 
symptoms  of  the  complaint  which  compelled  me 
to  take  the  holiday  vanished,  and  were  replaced 
by  a  buoyancy  and  feeling  of  well-being  such  as 
is  seldom  experienced  outside  youthful  years. 
At  first  I  thought  this  was  due  to  the  very  bracing 
sea  air  on  the  Cornish  coast  at  that  time  of  the 
year,  but,  being  some  hours  absent  from  my  rooms, 
the  effect  of  the  cough  mixture  wore  off  and  was 
succeeded  by  a  feehng  of  great  depression  and 
lassitude.  Upon  returning  to  my  quarters  and 
taking  another  dose  of  the  mixture,  the  buoyant 
feelings  returned.  I  became  suspicious  of  their 
source ;  I  decided  not  to  use  the  cough  mixture 
again  for  twenty-four  hours,  and  to  note  the 
effect.  Apparently  the  reaction  was  very  great, 
for  I  felt  extremely  ill  and  uncomfortable,  my 
legs  being  very  heavy,  was  disinclined  for  any 
exertion  whatever,  a  feeling  of  utter  prostration 
replacing  the  buoyancy  of  the  previous  hours. 
I  determined  to  make  another  test  of  the  mixture, 
and  took  one  or  two  doses  more.  The  result 
was  almost  immediate  ;  the  same  feeling  of 
buoyancy  and  youthfulness  returning.  I  then 
decided  that  the  heroin  in  the  mixture  was  the 
cause  of  this.     It  required  a  considerable  amount 


140  MODERN  TREATMENT  OF  ALCOHOLISM 

of  self-will  to  refuse  to  use  it  again.  It  is 
impossible  to  describe  in  words  the  fascinating 
effect  it  has  upon  one  and  the  terrible  reaction 
that  follows  its  withdrawal.  The  amount  of 
heroin  in  each  teaspoonful  of  the  preparation 
was  ^^jth  of  a  grain  of  the  hydrochloride,  and  this 
is  the  usual  dose  prescribed  in  cough  mixture. 
I  mention  this  danger  in  connection  with  the 
previous  case  in  order  to  emphasise  the  fact  that 
a  cough  mixture  of  this  nature  should  never  be 
taken  without  a  medical  man's  supervision. 
Personally,  I  consider  the  drug  not  only  more 
dangerous,  but  far  more  fascinating  than  mor- 
phine. 

Laudanum  Using 

I  have  already  remarked  that  opium  in  the 
form  of  the  gum  is  used  in  the  East  in  very  much 
the  same  way  that  alcohol  is  used  in  the  West, 
and  I  have  shown  how  it  affects  the  different 
races.  In  this  country  very  little  laudanum  is 
used  in  the  form  of  drug-taking  ;  at  least  it  has 
not  been  my  experience  to  come  across  many 
cases  of  the  kind.  The  habit  is  generally  acquired 
through  laudanum  being  prescribed  by  a  physician, 
and  being  continued  by  the  patient  long  after 
it  was  the  intention  of  the  doctor  that  it  should 
be.     One   of  my  recent  patients  was  a  case   of 


FORMS  OF  INEBRIETY  141 

this  sort.  On  inquiring  from  her  how  she  came 
to  get  accustomed  to  the  drug,  she  showed  me 
a  prescription  which  had  been  given  her  many 
years  before.  It  was  of  such  a  nature  that  there 
was  no  doubt  in  my  mind  that  the  physician 
who  wrote  it  did  not  intend  it  to  be  repeated  ; 
but  the  patient  had  been  taking  this  during  all 
these  years.  I  asked  her  if  the  doctor  who 
prescribed  the  medicine  knew  that  she  was  having 
the  prescription  repeated,  and  she  candidly  told 
me  that  she  had  never  informed  him  of  that  fact. 
The  habit  is  also  sometimes  acquired  by  using 
homely  remedies  for  mild  complaints,  especially 
by  people  who  have  lived  abroad  in  tropical 
countries  and  have  found  trouble  in  that  direction 
since  returning  home.  It  is  quite  true,  as  has 
been  stated  by  several  authorities,  that  these 
laudanum  takers  use  the  drug  for  a  considerable 
time  in  many  cases  without  apparently  any 
great  harm,  although  eventually  they  reach  a 
stage  akin  to  that  of  the  morphine  user.  I  have 
met  with  patients  who  take  a  certain  quantity  of 
opium  daily,  and  have  done  so  for  many  years, 
and  who  seem  to  be  in  more  or  less  perfect  health. 
Certainly  even  after  years  of  the  use  of  the 
drug  they  enjoyed  a  good  average  health.  One 
patient  in  particular  appeared  to  thrive  upon  it  ; 
instead   of  the   usual   sallow   or  earthen   colour 


142  MODERN  TREATMENT  OF  ALCOHOLISM 

of  many  drug  takers,  lie  had  a  particularly  fresh 
complexion,  although  lie  was  using  the  equivalent 
of  4  grains  of  opium  every  twenty-four  hours, 
and  had  been  doing  so  for  at  least  ten  or  twelve 
years.  While  this  is  true  in  general  of  those  who 
use  laudanum,  many  cases  rapidly  deteriorate 
under  its  use,  and  the  habit  becomes  a  very 
similar  one  to  that  of  morphine  taking.  It  is 
the  custom  of  a  number  of  physicians  to  prescribe 
small  doses  of  laudanum  daily  in  order  to  stimu- 
late the  peripheral  circulation  in  those  who 
suffer  from  cold  extremities.  On  asking  one  of 
our  eminent  specialists  who  was  fond  of  pre- 
scribing this  drug  in  such  cases,  if  he  had  ever 
known  any  of  his  patients  to  form  the  drug  habit 
in  these  circumstances,  he  told  me  that  although 
he  had  been  prescribing  it  regularly  to  a  number 
of  patients  during  the  last  thirty  years,  he  had 
never  yet  known  any  of  them  succumb  to  its 
fascination,  when  prescribed  in  small  doses  of 
the  tincture  of  opium.  These  cases  of  laudanum 
taking  are  very  easily  cured  in  comparison  with 
the  morphine  patients.  Their  sufferings  when  in 
an  advanced  stage  are  very  much  less. 

Paregoric,  or  the  ordinary  compound  camphor 
tincture  of  the  British  Pharmacopoeia,  is  another 
form  of  drug  which  may  induce  a  habit.  One 
of  the  most  remarkable  cases  of  this  sort  I  saw 


FORMS  OF  INEBRIETY  143 

was  that  of  a  woman  of  middle  age,  for  whom  the 
drug  had  been  prescribed  by  a  nurse  in  order  to 
reduce  the  abdominal  pains  occurring  subse- 
quent to  child-birth.  Finding  the  effect  agree- 
able in  many  ways,  she  continued  its  use  until 
she  found  that  she  could  not  give  it  up.  When 
she  came  to  me  for  treatment  she  was  taking 
40  oz.  of  the  paregoric  every  twenty-four  hours. 
The  effect  upon  her  was  of  a  peculiar  nature. 
She  was  of  an  almost  waxen  colour,  had  grown 
very  stout,  and  while  taking  the  drug  could  eat 
and  sleep  fairly  normally.  Yet  life  was  a  great 
burden  to  her  in  many  ways.  She  had  used  the 
drug  for  several  years  when  I  first  saw  her,  and 
for  the  last  four  or  five  of  these  the  normal  female 
functions  had  ceased  to  act,  although  she  was 
less  than  thirty -five  years  of  age.  On  withdrawing 
the  drug  and  restoring  her  health,  she  became 
quite  normal  in  every  respect,  and  apparently 
was  not  any  the  worse  for  the  habit. 

The  Chlorodyne  Habit 

Another  habit  of  importance  connected  with 
opium  is  that  of  chlorodyne  using.  I  have 
seen  only  a  few  of  these  cases,  and  do  not  think 
that  they  are  very  numerous,  or  one  would  be 
likely  to  hear  more  of  them.     One  can  readily 


144  MODERN  TREATMENT  OF  ALCOHOLISM 

understand    how   the    taking   of    chlorodyne    for 
the  rehef  of  pain  might  estabhsh  a  habit,  when 
one    considers    that    it    contains    a    considerable 
proportion  of  morphine  in  each  dose.     The  fact 
that  it  has  to  be  used  or  measured  out  in  drops 
may  help  to  prevent  the  spread  of  the  habit  to 
a  great   extent,  as   the   laity  are  generally  very 
cautious  in  taking  excessive  doses  of  medicines 
that  are  measured  in  drops.     This  is  fortunate, 
for  chlorodyne  is  a  very  fascinating  preparation, 
the  chloroform  which  it  contains  giving  it  a  very 
pleasant  taste.     I  have  known  children  become 
very  fond   of   the   chlorodyne   lozenge,  which   is 
sold  so  abundantly   as  a  cough  remedy  during 
the  winter    season.     I   have  also   known   people 
who  told  me  that  the  same   lozenge   had  a  very 
fascinating  effect  upon  them.     I   am  not   quite 
certain  that  they  all  contain  morphine,  but  those 
that  are  made  according  to  the  standard  formula 
must   do  so,  and  it  is  probably  these  that  pro- 
vide this  fascination.     I  invariably  warn  those  I 
meet    against    the    indiscriminate    use    of   them. 
It  is  only  a  step  from  the  chlorodyne  lozenge  to 
chlorodyne  itself,  and  one  does  occasionally  meet 
with  slaves  of  the  chlorodyne  habit.     It  is  practi- 
cally neither  more  nor  less  than  the  morphine 
habit,  but  fortunately  those  accustomed  to  taking 
it  in  the  form  of  chlorodvne  do  not  know  this, 


FORMS  OF  INEBRIETY  145 

or  they  would  buy  the  plain  alkaloid  and  use  a 
syringe.  The  very  expense  of  the  preparation 
has  a  tendency  to  curtail  the  habit  as  much  as 
possible.  One  patient  informed  me  that  if  she 
had  the  means  she  would  use  much  larger  quan- 
tities of  the  chlorodyne  than  she  was  able  to  do. 
It  was  only  when  her  sufferings  became  unbear- 
able that  she  was  obliged  to  find  the  means  of 
obtaining  another  supply. 

Treatment  of  course  will  be  discussed  later  on, 
but  it  is  practically  the  same  as  that  for  morphine. 

The  Chloral  Habit 

It  is  mostly  women  who  become  addicted  to 
this  form  of  drug  using.  It  is  begun  in  the  first 
place  for  insomnia  or  to  relieve  neuralgic  pains. 
It  is  not  so  much  used  now  as  formerly.  Whether 
this  is  due  to  the  greater  difficulty  in  obtaining 
the  drug,  a  better  knowledge  of  its  danger,  or  to 
its  being  replaced  by  one  of  the  more  recent 
hypnotics,  I  cannot  say,  but  probably  all  three  are 
in  various  degrees  responsible.  Something  may 
have  been  gained  by  the  replacing  of  this  dangerous 
drug  by  one  of  the  later  ones  of  the  present  day. 

The  greatest  danger  arising  from  the  use  of  this 

drug  is  in  its  depressing  action  upon  the  heart. 

This  is  so  well  known  to  medical  men  generally, 
10 


146  MODERN  TREATMENT  OF  ALCOHOLISM 

that  the  drug  is  not  a  favoured  one  with  them  on 
that  account.  Many  fatahties  have  occurred 
through  its  use,  and  this  has  so  affected  the  pre- 
scribing of  the  drug  that  it  has  almost  practically 
dropped  out  of  use.  This  being  true  of  the  pro- 
fessional use  of  the  remedy,  how  much  more 
dangerous  it  is  for  the  laity  to  use  who  do  not 
even  understand  its  particular  effects  upon  the 
system.  A  patient  would  be  much  more  safe  in 
the  use  of  morphine  than  in  the  use  of  chloral, 
for  morphine  has  practically  the  opposite  effect 
upon  the  vital  organ — the  heart — to  that  of 
chloral.  It  has  been  lately  claimed  by  one 
authority,  that  less  fatahty  attends  the  use  of 
chloral  at  the  present  day  than  formerly,  and 
this  is  considered  to  be  due  to  a  purer  prepara- 
tion of  the  drug.  Whether  this  is  true  or  not, 
the  fact  remains,  that  chloral  is  one  of  the  most 
dangerous  drugs  the  laity  can  use.  Certainly  it 
should  never  be  taken  excepting  under  the  direct 
supervision  of  a  medical  man,  and  a  prescription 
containing  this  drug  should  never  be  repeated  by 
a  chemist  unless  he  is  quite  satisfied  that  it  was 
the  intention  of  the  physician  that  it  should  be. 

Chloroform 

The  chloroform  habit  is  another  very  dangerous 
one.     It  is  genei^lly  resorted  to  in  order  to  pro- 


FORMS  OF  INEBRIETY  147 

cure  sleep  or  to  soothe  pain.  To  induce  sleep  the 
patient  usually  retires,  then  wets  a  handkerchief 
with  some  of  the  drug,  and,  lying  on  his  side,  holds 
the  handkerchief  to  his  face  ;  as  the  drug  takes 
effect  the  arm  drops  and  he  gets  no  more  of  the 
drug.  This  he  may  do  often  without  harm,  but 
"  familiarity  breeds  contempt,"  and,  as  has  too 
often  happened,  he  gets  careless  in  assuming  a  safe 
position,  and  instead  of  the  handkerchief  being 
removed  it  falls  across  his  face  and  he  may  never 
awake. 

I  once  had  an  experience  in  a  dentist's  chair 
which  showed  me  how  very  fascinating  this  form 
of  drug-taking  is.  Being  unwilling  to  allow  the 
dentist  to  administer  the  chloroform  by  himself, 
I  at  his  request  put  a  few  drops  of  the  drug  on  a 
handkerchief,  which  he  asked  me  to  place  to  my 
face,  and  take  it  away  as  soon  as  I  felt  myself 
getting  drowsy,  which  I  did,  while  he  extracted 
the  tooth  without  my  feeling  any  pain  whatever. 
During  the  extraction  I  felt  no  pain,  but  on  the 
contrary  experienced  a  most  pleasant  sensation, 
which,  had  I  not  been  a  doctor,  might  have  led 
me  to  resort  to  the  use  of  chloroform  on  numerous 
occasions. 

Another  drug  we  desire  to  mention  in  connec- 
tion with  the  drug  habit  is  Cocaine.  Cocaine  is 
another  very  fascinating  drug,  and  is  very  much 


148  MODERN  TREATMENT  OF  ALCOHOLISM 

more  largely  used  secretly  than  is  generally 
supposed.  Fortunately,  the  habit  of  taking 
cocaine  is  more  amenable  to  treatment  than  that 
of  taking  most  drugs  of  its  class.  It  is  a  habit 
which  is  very  easily  acquired,  and  the  risk  of  doing 
so  is  much  greater  than  the  general  public  are 
aware  of.  Many  of  the  catarrh  snuffs  on  sale  in 
chemists'  shops  contain  a  proportion  of  this  drug. 
The  danger  of  having  such  a  powerful  drug  on 
sale  in  this  manner  can  be  best  inferred  from  the 
history  of  a  patient  of  mine.  The  patient  was  a 
veterinary  surgeon,  a  man  of  unusual  physique 
and  robustness,  accustomed  to  live  out  of  doors 
practically  the  whole  time  ;  a  man  of  strong  will- 
power and  perfect  health.  He  was  about  the 
last  sort  of  person  that  one  would  expect  to 
become  a  drug-taker.  Contracting  a  chill  one 
day,  he  called  upon  a  local  chemist  and  asked  him 
for  something  to  relieve  the  cold  in  his  head. 
One  of  the  ordinary  catarrh  snuffs  was  given  him, 
and  the  effect  was  very  rapid  and  very  satis- 
factory as  far  as  the  cold  in  the  head  was  con- 
cerned. Later  on,  on  taking  another  chill,  he 
used  another  bottle  of  the  same  snuff.  The  relief 
was  so  great  and  so  quickly  attained  that  he 
decided  to  keep  a  supply  of  this  preparation  by 
him.  He  told  me  that  he  had  not  the  faintest 
idea   there   was   anything   dangerous   about   the 


FORMS  OF  INEBRIETY  149 

preparation.  He  used  it  on  several  subsequent 
occasions  whenever  he  felt  a  stuffiness  in  the  head, 
and  always  with  immediate  relief.  A  few  weeks 
afterwards  he  was  surprised  to  find  that  he  was 
taking  it  rather  frequently.  He  decided  to  take 
it  no  more,  but  to  his  surprise  and  horror  he  found 
that  he  could  not  do  without  it  ;  he  had  become 
a  cocaine  fiend.  He  made  a  very  determined 
fight  to  conquer  the  habit,  but  in  spite  of  his 
splendid  physique  and  his  will-power  he  became 
more  hopelessly  involved  in  the  meshes  of  the 
habit.  He  was  finally  placed  in  a  private  asylum, 
owing  to  the  effect  of  the  drug  making  him 
dangerous  to  those  about  him.  In  his  madness 
he  leapt  from  an  upper  window  and  received 
very  severe  injuries,  breaking  a  number  of  his 
bones  and  being  badly  bruised  in  general.  As 
soon  as  he  was  in  a  condition  to  be  removed  he 
was  brought  to  my  sanatorium  for  treatment,  and 
it  was  while  there  that  I  obtained  from  him  the 
above  history.  When  one  considers  the  effect 
of  this  drug  upon  a  strong,  healthy  man  such  as  he 
was,  one  trembles  to  think  of  the  likely  result 
upon  delicate  women  and  even  children. 

The  danger  of  selling  preparations  containing 
cocaine  has  been  recognised  by  several  States 
of  the  American  Union,  and  laws  have  been 
enacted  prohibiting  the  sale  of  the  drug  in  those 


150  MODERN  TREATMENT  OF  ALCOHOLISM 

States,  excepting  under  very  restricted  con- 
ditions. 

The  difference  in  effect  of  taking  this  drug  from 
that  of  taking  heroin  is  chiefly  in  its  effect  upon 
the  higher  centres.  While  heroin  does  not 
specially  affect  the  mental  condition,  cocaine 
seems  to  waste  most  of  its  energy  in  that  direction. 
Cocaine  takers  are  apt  to  do  the  most  wild  and 
outrageous  things.  They  apparently  lose  all 
sense  of  moral  responsibihty  and  proportion. 
One  is  never  surprised  to  hear  of  the  actions  of  a 
cocaine  fiend  being  of  the  maddest  possible  nature. 

One  of  my  patients  became  addicted  to  its 
use  in  the  following  way  :  When  visiting  a  friend's 
room  one  night  he  mentioned  that  he  had  a  head- 
ache. His  friend  told  him  that  he  could  soon  cure 
that  for  him,  and  gave  him  an  injection  of  cocaine. 
His  headache  soon  left  him.  A  few  days  after  he 
cured  another  headache  in  the  same  way.  A  week 
later  he  did  the  same, — then  found  that  he  could 
not  do  without  the  drug.  He  became  a  physical 
and  mental  wreck  ;  he  was  arrested  in  the  street  as 
an  insane  person,  and  his  friends  had  great  diffi- 
culty in  getting  him  out  of  the  hands  of  the  law. 

Cocaine  is  an  alkaloid  obtained  from  the 
coca  leaves.  The  leaves  themselves  have  a  very 
stimulating  effect  upon  those  who  use  them.  The 
Indians  of  South  America  are  known  to  chew  coca 


FORMS  OF  INEBRIETY  151 

leaves  in  order  to  enable  them  to  carry  heavy 
burdens  over  long  distances  and  to  climb  moun- 
tains without  undue  fatigue.  When  taken  in 
this  form,  the  habit  does  not  seem  to  be  contracted 
in  the  same  way  as  when  the  alkaloid  cocaine  is 
taken  by  itself.  We  ourselves  have  tested  its 
use  in  connection  with  our  army  in  order  to 
ascertain  whether  our  men  could  stand  a  more 
fatiguing  march  by  its  use  than  otherwise.  For 
some  reason  or  another  we  have  not  heard  any- 
thing further  of  its  use  in  that  direction. 

Athletes  at  one  time  were  accustomed  to  chew 
the  leaves  before  entering  upon  some  strenuous 
competition.  To  a  great  extent  I  believe  that 
that  has  also  dropped  out  of  fashion,  but  it  is 
said  that  in  some  of  the  recent  Marathon  races 
a  well-known  athlete  used  these  leaves  to  sustain 
his  strength  during  the  contest.  That  he  came 
in  fresher  than  most  of  his  competitors  might  be 
accounted  for  in  this  way. 

There  are  several  preparations  upon  the  market 
containing  an  extract  of  the  leaves  and  sold  as 
tonics.  The  general  public  will  be  well  advised 
to  take  none  of  these  preparations  without  first 
consulting  their  doctor. 

This  drug  is  much  used  by  quacks  in  their 
remedies  for  alcoholism,  but  the  only  result  is  to 
replace  one  form  of  habit  bv  another. 


152     MODERN  TREATMENT  OF  ALCOHOLISM 

Indian  Hemp 

The  taking  of  Indian  hemp  is  seldom  if  ever 
met  with  in  this  country,  but  it  is  much  used  in 
India  in  the  form  of  hashish.  It  is  interesting 
merely  from  the  strange  delusions  which  some- 
times follow  its  use. 

It  has  been  recommended  by  some  as  of  use 
in  the  treatment  of  the  morphine  habit,  and  I 
once  administered  it  to  a  patient  with  this  in- 
tention. The  effect  was  very  striking  ;  although 
I  took  the  precaution  to  administer  only  half 
the  usual  dose,  yet  the  patient  had  a  most  curious 
delusion.  After  administering  this  dose  I  sat 
down  beside  the  patient  in  order  to  watch  its 
effect.  Nothing  occurred  for  a  few  minutes, 
and  we  were  engaged  in  ordinry  conversation 
when  I  noticed  a  strange  look  come  into  the  face 
of  my  patient.  He  ceased  his  conversation,  and 
sat  staring  with  increasing  alarm  at  a  chair 
opposite  him  some  three  or  four  feet  away.  On 
inquiring  what  was  troubhng  him,  he  told  me  in 
horrified  accents  that  he  was  splitting  into  two  ; 
one  half  of  him,  or  rather  a  double  of  him,  was 
passing  from  him  and  placing  itself  upon  this 
chair.  He  said,  "  Now  it  is  sitting  looking  at 
me  ;  there  are  two  of  us,  and  yet  both  are  myself." 
I  had    some    considerable     difficulty   in   allaying 


FORMS  OF  INEBRIETY  153 

his  apprehension  by  telhng  him  that  it  was 
merely  the  effect  of  the  drug  which  I  had  ad- 
ministered, and  that  after  a  certain  time  this 
would  pass  away  and  his  "  double  "  would  dis- 
appear. This  took  effect  shortly  afterwards, 
greatly  to  his  relief.  He  assured  me  that  he 
would  not  undergo  the  experience  again  for  any- 
thing, and  asked  me  to  try  some  other  method 
in  order  to  cure  his  morphine  habit. 

I  am  told  by  those  interested  in  the  subject 
that  the  drug  is  used  in  India  in  order  to  produce 
this  very  effect.  It  is  said  that  by  its  use  it  is 
much  easier  to  project  the  astral,  when  it  is 
desired  to  do  so.  Considering  the  effect  that  I 
have  already  related  in  the  case  of  my  patient, 
I  should  think  that  this  is  most  likely  to  be  the 
case.  One  reason  why  it  has  not  become  more 
popular  in  this  country  may  be  this  very  alarming 
effect. 

Sleeping  Powders 

There  is  another  class  of  drugs  which,  while 
considered  quite  harmless,  are  far  from  being  so. 
I  refer  to  the  hypnotics  Sulphanol,  Trianol,  and 
Veronal.  When  each  of  these  was  put  upon 
the  market  it  was  lauded  to  the  skies  as  a  perfect 
and  harmless  remedy  for  insomnia,  but  my 
experience   convinces  me   that   they   are   not   so 


T54  MODERN  TREATMENT  OF  ALCOHOLISM 

harmless  as  they  are  claimed  to  be.  The  question 
of  interest  to  us  is  whether  or  not  they  are  hkely 
to  form  drug  habits.  As  I  have  had  to  treat 
several  patients  addicted  to  their  use,  there 
cannot  be  any  doubt  of  their  being  able  to 
produce  the  drug  habit. 

The  victims  of  this  form  of  drug  habit  begin 
their  use  as  a  remedy  for  insomnia,  thinking  them 
to  be  quite  harmless,  and  later  on  find  that  they 
could  not  do  without  them.  As  the  effects  of 
the  drug  wears  off  distressing  symptoms  appear, 
to  relieve  which  greater  quantities  are  taken, 
until  the  patient  becomes  a  nervous  wreck, 
with  delusions  of  a  marked  character.  Most 
of  the  victims  of  these  drugs  are  chemists  ; 
sometimes  a  patient  is  met  with  of  our  own 
profession,  but  chiefly  the  supply  of  patients 
comes  from  among  the  former  class.  The 
delusions  which  these  patients  suffer  are  very 
marked,  and  generally  harmless,  although  in 
one  or  two  cases  homicidal  tendencies  occur. 

Trianol  was  responsible  for  one  of  my  cases, 
the  victim  being  a  young  chemist  who  resorted 
to  the  drug  in  the  first  place  in  order  to  over- 
come insomnia.  Not  being  able  to  leave  his 
business  and  take  a  proper  holiday,  he  found  it 
necessary  to  resort  to  the  drug  more  or  less 
frequently  in  order  to  secure  a  good  night's  rest. 


FORMS  OF  INEBRIETY  155 

Finally  the  effect  lasted  throughout  the  whole 
twenty-four  hours.  The  quantity  of  the  drug 
taken  in  order  to  procure  sleep  was  such  that  he 
was  quite  unable  to  longer  attend  to  his  business 
during  the  day,  owing  to  the  very  confused  con- 
dition of  his  mind  during  the  waking  hours. 
After  entering  the  sanatorium  for  treatment 
these  delusions  lasted  quite  forty-eight  hours  ; 
the  patient  was  very  excited  and  constantly  in 
trouble  of  some  sort,  but  otherwise  harmless 
enough,  nor  was  he  noisy.  A  cure  was  not 
difficult,  in  this  respect  differing  greatly  from  that 
of  some  of  the  older  forms  of  hypnotics. 

Sulphanol  was  responsible  for  two  cases  which 
I  had  to  treat  ;  the  symptoms  were  very  similar 
to  those  of  trianol,  and  in  fact  it  was  impossible 
to  tell  the  one  form  of  drug-taking  from  the 
other.  The  treatment  was  likewise  satisfactory 
in  both  of  these  cases. 

Veronal  is  considered  to  be  a  perfectly  harmless 
hypnotic  by  a  large  majority  of  users.  I  have 
seen  several  marked  cases  of  habit  resulting  from 
the  use  of  this  drug.  One  of  these  was  that  of  a 
medical  man  who  had  taken  the  drug  to  produce 
sleep.  Those  who  are  accustomed  to  administer 
this  drug  know  that  the  original  form  of  it  is 
very  difficult  of  solution,  and  in  order  to  obtain 
this   it   was   necessary   to   dissolve   the   drug   in 


156  MODERN  TREATMENT  OF  ALCOHOLISM 

boiling  water.  If  this  was  not  done,  the  drug 
dissolved  so  slowly  in  the  system  that  the  effect 
was  not  apparent  until  some  time  during  the 
next  day  if  administered  at  bedtime.  The  patient 
to  whom  I  have  referred  was  not  aware  of  this 
need,  and  finding  that  a  dose  which  he  had  taken 
in  cold  water  was  not  having  any  effect  after  an 
hour  or  so,  resorted  to  another  dose.  Naturally 
he  got  no  result,  and  each  hour  for  several  hours 
he  took  succeeding  doses,  thinking  that  he  had 
not  taken  enough  of  the  drug  to  overcome  his 
insomnia.  The  next  afternoon  the  whole  of 
this  large  quantity  of  drug  took  effect,  with  the 
result  that  he  nearly  lost  his  life.  It  was  very 
difficult  to  arouse  him  for  many  hours  after  he 
first  went  to  sleep,  and  he  remained  drowsy, 
sleeping  almost  continuously  for  nearly  a  week. 
During  this  time  it  was  very  difficult  to  admin- 
ister nourishment.  All  reflexes  w^ere  completely 
abolished,  and  the  result  was  a  very  sad  one 
indeed.  On  coming  out  from  under  the  influence 
of  the  drug  he  piteously  asked  for  more,  which 
of  course  was  not  given  him  ;  but  a  habit  had 
been  formed,  for  no  sooner  w^as  he  able  to  obtain 
the  drug  than  he  resorted  to  it  again,  and  con- 
tinued to  do  so  until  he  had  received  a  proper 
course  of  treatment.  He  told  me  that  after 
the  effect  of  the  drug  wore  off  most  distressing 


FORMS  OF  INEBRIETY  157 

symptoms  set  in,  symptoms  which  even  as  a 
medical  man  he  could  not  describe,  they  were  so 
vague  and  generalised,  but  he  assured  me  that 
they  caused  most  intense  suffering,  and  that 
nothing  seemed  of  importance  at  the  time  but 
the  allaying  of  these  symptoms.  The  mental 
condition  which  followed  the  use  of  this  drug 
in  this  particular  case  was  most  marked,  the  mind 
remaining  very  feeble  and  the  intellect  weak  for 
some  two  or  three  weeks.  The  effect  upon  the 
muscular  system  was  also  very  marked.  The 
ability  to  walk  with  any  degree  of  firmness  was 
not  obtained  for  quite  a  month  after  the  cessation 
of  all  use  of  the  drug.  I  am  not  quite  sure  that 
the  patient  ever  fully  recovered  from  the  effect 
of  the  poison.  Another  case  was  that  of  a 
patient  who  had  returned  from  India  on  leave. 
Being  afflicted  with  insomnia,  he  had  resorted  to 
the  drug,  being  told  it  was  quite  harmless.  He 
was  under  treatment  for  three  months,  mania 
of  a  marked  character  being  in  full  play  when 
I  first  saw  the  case,  and  so  violent  was  he  at 
times  that  he  required  two  attendants  constantly 
day  and  night.  Even  after  the  subsidence  of 
the  mental  excitement,  which  did  not  occur 
for  several  weeks,  his  mental  condition  was  in  a 
deplorable  state,  but  he  gradually  and  slowly 
recovered.     During  his  illness  I  had  a  consulta- 


158  MODERN  TREATMENT  OF  ALCOHOLISM 

tion  with  one  of  our  leading  alienists,  and  his 
opinion  was  that  the  man  was  hopelessly 
insane  and  incurable.  I  am  glad  to  be  able 
to  say  that  he  practically  recovered  and  became 
normal. 

Owing  to  the  difficulty  of  dissolving  the  drug, 
the  makers  have  issued  a  soluble  form  called 
veronal  sodium.  This,  while  no  less  dangerous 
for  use  indiscriminately  and  in  undue  doses, 
lessens  the  danger  of  taking  too  much  of  the 
drug,  owing  to  its  ready  solubility  and  rapid 
effects. 

Considering  that  one  meets  fairly  often  with 
patients  who  have  come  under  the  sway  of  the 
drug,  it  cannot  be  called  a  harmless  one,  and  the 
laity  ought  not  to  use  it  without  a  medical  man's 
supervision,  and  doctors  ought  not  to  prescribe 
it  in  the  same  careless  way  as  apparently  has 
existed  up  to  the  present. 

There  is  a  drug  in  very  common  use  about 
which  I  should  like  to  say  a  word  while  on  the 
subject  of  the  drug  habit.  It  is  commonty  known 
by  the  name  of  Bromide.  The  form  most  used 
is  the  bromide  of  potassium.  It  is  one  of  the 
most  useful  drugs  we  have,  and  one  of  the  most 
frequently  used.  Now  one  may  search  widely 
in  books  dealing  with  the  action  of  medicines 
without  finding  any  reference  to  the  danger  of 


FORMS  OF  INEBRIETY  159 

acquiring  from  its  use  such  a  habit  as  I  am  about 
to  describe.  On  the  other  hand,  one  will  often 
find  a  statement  to  the  effect  that  the  drug  is 
perfectly  harmless  ;  this  is  the  experience  of  the 
writers  of  those  books,  and  holds  good  in  a  great 
majority  of  cases.  The  patient  I  am  about  to 
describe  was  suffering  from  neurasthenia,  and 
had  read  in  some  medical  work  of  the  harmless- 
ness  of  bromides,  and  acquired  a  quantity  of  the 
drug  in  the  hope  that  it  would  quiet  his  nerves. 
The  effect  on  him  w-as  startling.  The  first  night 
he  used  the  drug  I  was  called  to  his  room,  and 
found  him  in  a  state  of  great  excitement  and  the 
room  in  great  confusion.  He  became  so  violent 
that  he  had  to  be  put  into  a  strait-jacket.  He 
had  to  be  kept  in  this  for  three  weeks.  As  this 
was  contrary  to  all  my  previous  experience  of 
the  drug,  I  could  not  believe  that  it  was  due  to  the 
bromide  he  had  taken,  but  was  compelled  to  do 
so  when  he  had  several  subsequent  attacks.  In 
every  one  of  these  attacks  a  quantity  of  bromide 
was  found  on  him  and  no  other  drug.  I  only 
mention  this  to  show  that  in  some  cases 
it  does  affect  the  patient  in  a  remarkable 
manner. 

The  means  to  which  a  patient  will  resort  when 
he  cannot  get  alcohol  may  be  of  interest  to  the 
student  of  inebriety,  and  concludes  this  part  of 


i6o  MODERN  TREATMENT  OF  ALCOHOLISM 

our  subject.  Alcoholics  will  use  many  strange 
substitutes  for  alcohol,  such  as  methylated  spirits, 
varnish,  perfume,  paraffin,  etc.  If  you  notice 
them  at  table  you  will  find  that  they  use  large 
quantities  of  mustard  and  pepper,  being  parti- 
cularly fond  of  cayenne.  They  will  season  their 
food  to  such  an  extent  that  other  people  could  not 
possibly  eat  it,  the  sensitiveness  of  their  palate 
being  largely  lost.  For  the  same  reason  they 
take  very  large  helpings  of  relishes,  Worcester 
sauce  being  a  favourite.  One  of  the  most  violent 
attacks  of  delirium  tremens  I  ever  saw  was  in  a 
patient  who  had  drunk  several  bottles  of  this 
sauce.  Many  men  resort  to  patent  medicines 
and  tonic  mixtures  in  order  to  conceal  their 
drinking  habits.  Women  are  fond  of  essence  of 
ginger  or  peppermint — it  is  a  respectable,  if  costly, 
method  of  drinking.  These  preparations  contain 
a  large  proportion  of  alcohol,  and  it  is  for  this 
that  they  are  often  taken. 

Many  suffer  from  a  thirst  habit,  aside  from 
any  craving  for  stimulants,  and  take  all  sorts  of 
liquids  at  frequent  intervals.  I  had  a  patient 
who  was  remarkable  in  this  way  :  he  would  drink 
half  a  gahon  of  water  every  hour  during  the  day, 
although  it  was  winter-time,  and  I  had  to  treat 
this  condition  as  well  as  alcoholism.  There  was 
no  other  disease  present  to  account  for  this  great 


FORMS  OF  INEBRIETY  i6i 

thirst  ;  it  was  merely  a  habit.  It  is  a  very 
common  practice  for  these  patients  to  eat  large 
quantities  of  sweets  when  they  are  not  using 
alcohol,  but  they  never  take  them  when  using 
the  spirits. 


zz 


CHAPTER  V 

TREATMENT 

We  now  come  to  the  question  of  the  treatment 
of  inebriety.  It  is  impossible  in  a  small  work 
of  this  kind  to  attempt  to  describe  all,  or  even 
a  large  number,  of  the  methods  of  treatment  used 
for  this  purpose  ;  and  although  they  might  be 
interesting  reading,  they  would  not  assist  us  much 
in  curing  our  patients.  The  first  essential  in 
the  treatment  of  alcoholism  is  to  recognise  that 
inebriety  is  a  disease.  Unnecessary  as  this  state- 
ment may  seem,  yet  we  find  many  to-day  who 
do  not  believe  it,  and  it  stands  to  reason  that 
if  the  doctor  starts  with  the  belief  that  his  patient 
has  no  disease,  he  is  not  likely  to  cure  him. 

Admitting  alcohohsm  to  be  a  disease,  it  is  our 
duty  as  doctors  to  find  a  remedy  for  the  complaint. 
One  of  the  objects  of  this  book  is  to  show  that 
such  a  remedy  has  been  found,  and  in  what  cases 
it  is  successful,  and  how  to  administer  it  in  order 
to    obtain    the    best    results.     The    question    of 

treatment  may  be  divided  into  several  divisions, 

162 


TREATMENT  163 

namely,  the  moral  treatment,  the  treatment  by 
restraint,  the  treatment  by  law,  the  treatment 
by  diet,  etc.,  and  the  treatment  by  drugs.  The 
method  or  methods  of  treatment  pertaining  to 
each  of  these  divisions  are  essential  to  success. 
We  are  not  only  dealing  with  the  physical  body, 
but  with  human  nature  in  all  its  various  com- 
plications, and  we  are  compelled  to  consider  our 
patients  in  relation  to  the  question  of  heredity, 
of  environment,  of  social  customs,  social  status, 
of  climate  and  even  race.  The  religious  belief 
of  the  patient  may  have  to  be  taken  into  account. 
It  is  evident  that  no  "  rule  of  thumb  "  will  serve 
us  here.  A  very  broad  conception  of  the  wliole 
question  and  a  combination  of  the  various 
methods  is  necessary  if  we  wish  to  be  successful 
in  the  treatment  of  the  majority  of  our  patients. 
I  am  convinced  that  this  very  lack  of  combina- 
tion accounts  for  so  many  recorded  failures. 
Let  us  take  these  various  methods  of  treatment 
in  their  order,  and  study  their  effect  upon  the 
different  varieties  of  the  disease. 

The  Moral  Treatment  of  Alcoholism 

There  is  only  one  class  of  inebriate  which  is 
likely  to  benefit  much  by  this  method  alone.  This 
is  the  voluntary  drinker.     Yet  this  form  of  treat- 


i64  MODERN  TREATMENT  OF  ALCOHOLISM 

ment  must  play  an  important  part  in  every  method 
used  to  treat  all  alcoholics,  if  success  is  desired. 
If  any  one  method  of  treatment  has  been 
thoroughly  sifted  and  tried,  surely  this  has.  It 
counted  on  its  side  enormous  forces,  such  as  the 
prayers  and  pleadings  of  loving  ones,  the  stern 
admonition  of  fathers,  the  fear  and  punishment 
of  the  law  ;  all  have  been  tried  for  ages  with  but 
a  moderate  success,  and  that  almost  entirely  con- 
fined to  one  class  of  excessive  drinkers.  This  is 
the  method  of  treatment  adopted  in  go  per  cent, 
of  all  cases  of  inebriety  ;  and  as  successful 
results  are  in  an  inverse  proportion  to  the  number 
of  patients  so  treated,  it  is  worth  our  while 
studying  closely  the  reason  of  this  failure.  There 
is  an  old  saying  that  "  failures  may  be  the 
stepping-stones  to  success,"  and  there  can  be 
no  doubt  that  the  failure  to  cure  alcoholism 
by  moral  methods  has  led  to  a  discovery  of  the 
real  nature  of  the  complaint,  and  consequently 
to  its  successful  treatment.  That  the  moral 
treatment  of  inebriety  is  a  failure  in  the  great 
majority  of  cases  is  not  only  evident  all  about 
us,  but  is  freely  admitted  by  all  who  have  ex- 
perience of  such  methods.  While  moral  treatment 
should  be  tried  in  all  cases,  there  is,  as  we  have 
said,  one  class  of  alcoholics  who  are  mostly 
to  be  benefited  by  this  method — the  voluntary 


TREATMENT  165 

drinkers.  They  are  not  alcoholics  in  the  true 
meaning  of  the  term.  They  may  be  physically 
sound,  and  generally  are.  They  have  no  craving 
for  stimulants.  After  a  night's  drinking  there 
is  no  desire  to  renew  the  experience — at  least, 
for  the  time  being.  They  are  morally  afflicted, 
not  physically.  It  is  a  case  here  of  curing 
the  mind,  not  the  body  ;  consequently  the 
moral  method  of  treatment  is  the  only  one 
likely  to  be  of  any  use  in  these  cases.  The 
parson  rather  than  the  doctor  is  the  proper 
one  to  take  charge  of  such  cases,  and  is  more 
likely  to  do  them  good.  There  is  here  a  proper 
field  of  work  for  the  temperance  organisations  as 
well  as  the  clergy.  Let  one  of  these  subjects 
of  alcoholism  join  a  church  or  a  temperance 
society  and  his  drinking  habits  will  fall  away 
from  him  like  a  loose  garment.  It  is  immaterial 
to  the  question  how  often  he  gets  drunk  in  the 
year  ;  once  his  mind  is  changed  he  is  as  soundly 
cured  as  if  he  had  never  got  drunk  in  his  life. 
There  is  no  question  of  any  physical  disease  to  be 
remedied,  no  insatiable  craving  to  be  removed — 
simply  a  change  of  the  mind  and  he  is  cured. 
It  all  seems  so  simple,  yet  some  of  these  cases 
are  the  most  difficult  of  all  to  treat.  Many  of 
these  inebriates  do  not  see  why  they  should 
change   their  mind   and  give   up  drinking,   and 


i66  MODERN  TREATMENT  OF  ALCOHOLISM 

herein  lies  the  v.hole  difficulty.  They  cannot 
see  why  they  should  deprive  themselves  of  what 
they  are  pleased  to  term  their  "  fun."  They  are 
quite  prepared  to  defend  their  drinking  by 
quoting  from  Scripture,  etc.,  by  referring  to 
the  fact  that  they  are  "  three-bottle  "  men,  and 
as  likely  as  not  look  upon  all  abstainers  with 
contempt  because  they  cannot  do  likewise. 
I  am  inclined  to  think  that  the}'  rather  glory 
in  their  ability  to  "  take  their  drink  like  a  man." 
What  are  we  to  do  with  such  alcoholics  ?  To 
brutally  call  them  drunkards  is  to  offend  them 
beyond  hope  of  foigiveness.  If  another  alcoholic 
is  pointed  out  to  them  as  an  object-lesson,  they 
say,  "  Yes,  poor  devil  !  " — pity  him,  but  never 
for  one  moment  do  they  imagine  themselves 
likely  to  be  classed  with  such.  Get  them  to 
change  their  views  of  the  question  if  you  can  ; 
by  any  and  every  means  possible  get  them  to 
sign  the  pledge  or  join  the  church,  or  marry 
some  good  woman  who  is  able  to  exercise  the 
necessary  influence.  Many  a  man  who '  has 
resisted  all  other  influence  has  yielded  to  the 
wish  of  some  sweet-dispositioned  worn. an.  A 
snapshot  of  them  when  at  their  worst  shown  to 
them  when  sober  has  sometimes  been  successful, 
for  until  the\^  can  see  for  themselves  they  will 
never  believe  any  description  of  the  condition  they 


TREATMENT  167 

got  into  when  drinking.  If  the  class  of  alcoholics 
of  which  I  have  been  writing  would  follow  the 
experience  of  a  friend  of  mine,  they  would  prob- 
ably do  as  he  did  and  give  up  drinking.  Having 
made  a  bet  that  he  would  not  take  a  drink 
that  evening,  he  had  the  unusual  experience  of 
watching  his  companions  go  through  their  usual 
custom  of  getting  drunk  while  he  kept  sober. 
As  they  grew  merry  he  rather  regretted  that  he 
could  not  drink  with  them  as  usual ;  but  when 
their  merriment  passed  into  the  maudlin  stage 
he  was  compelled  to  leave  them.  His  disgust 
was  so  great  that  he  never  got  drunk  again. 
It  is  a  great  pity  that  "  Dick  sober  "  cannot  see 
"  Dick  drunk  "  ;  it  would  cure  nine  out  of  every 
ten  cases  of  voluntary  drinkers. 

We  now  come  to  the  question  of  the  treatment 
of  alcoholism  by  Restraint.  Prior  to  the  publica- 
tion of  my  method  of  treatment  in  1904  in  the 
British  Medical  Journal,  treatment  by  restraint 
was  the  only  method  used  in  this  country  in 
recognised  homes  and  sanatoria,  and  that  is 
largely  the  case  to-day.  There  is  an  old  saying 
that  "  old  customs  die  hard,"  and  this  is  parti- 
cularly true  to  all  methods  of  treatment.  The 
treatment  of  alcoholism  by  restraint  has  perhaps 
some  excuse  for  its  lingering  demise  in  unsuitable 
cases,  because  of  its  usefulness  in  the  treatment 


i68  MODERN  TREATMENT  OF  ALCOHOLISM 

of  a  small  percentage  of  cases.  One  has  only 
to  read  the  literature  on  the  subject  to  ascertain 
how  slowly  the  old  faith  dies.  When  one  asks 
these  lovers  of  antiquities  why  they  do  not 
try  the  newer  methods,  they  have  one — and  only 
one — answer,  namely,  "  I  have  had  cases  come  to 
me  which  have  been  treated  by  the  drug  method 
and  which  have  not  been  cured,  therefore  it 
cannot  be  any  good.  Wliy  then  try  it  ?  "  Be- 
cause they  have  met  with  cases  which  have  been 
failures  under  the  system  of  treatment  by  drugs 
they  condemn  the  whole  system.  They  do  not 
know,  or  care  to  know,  whether  these  were 
suitable  cases  or  not.  It  is  quite  enough  for 
them  that  they  can  find  an  unsuccessful  case 
to  condemn  the  whole  treatment.  If  their 
own  method  of  treatment  was  judged  by  the 
same  standard  they  would  no  longer  be  justified 
in  receiving  patients  for  treatment.  Foolish  as 
such  an  answer  may  be,  I  am  sorry  to  say  it  is 
the  only  one  I  have  ever  been  able  to  get  from 
these  men.  As  to  failures,  I  know  of  no  method 
of  treatment  for  alcoholism  which  is  such  a 
dismal  failure  as  treatment  by  restraint.  Often 
the  reports  of  homes  advocating  restraint  are 
stamped  with  failure  on  the  face  of  them.  As 
to  what  the  patients  of  such  homes  think  of  the 
results  obtained  by  treatment  there,  it  is  hardly 


TREATMENT  169 

fair  to  say,  as  they  may  be  prejudiced,  but  this 
I  will  say — out  of  several  liundred  of  them  to 
whom  I  have  put  the  question  I  do  not  remember 
one  patient  who  had  a  good  word  to  say  of 
either  the  treatment  or  its  result,  while  what  they 
did  say  would  not  be  pleasant  reading  for  those 
in  charge  of  these  places.  Nevertheless,  treatment 
by  restraint  has  its  proper  and  useful  place,  and 
for  a  certain  class  of  patient  it  is  essential. 
Where  the  mistake  is  so  often  made  is  in  applying 
the  treatment  to  all  classes  of  alcoholism.  If 
we  examine  the  different  classes  of  alcoholism 
in  connection  with  this  method,  we  will  readily 
see  where  it  is  likely  to  prove  useful  and  where 
it  is  bound  to  fail.  Let  us  take  the  classification 
of  alcoholism  as  laid  down  in  this  book,  and 
proceed  to  examine  each  section  in  relation  to 
treatment  by  restraint. 

The  first  section  we  have  is  that  of  the  daily  or 
constant  drinker.  In  this  class  we  have  to  deal 
with  a  patient  who  has  contracted  a  craving  for 
alcohol.  This  craving  has  become  uncontrollable, 
and  the  patient  satisfies  it  whenever  he  can. 
Knowing  this,  those  in  favour  of  treatment  by 
restraint  say,  "  Let  us  shut  this  man  up  for  two, 
three,  five,  or  seven  years  where  he  cannot  get  the 
alcohol,  and  by  the  time  we  let  him  out  he  will 
have  learned  to  do  without  it.     We  will  see  that 


170  MODERN  TREATMENT  OF  ALCOHOLISM 

he  has  plain  diet,  exercise,  and  hght  and  agreeable 
occupation.  In  short,  they  say,  "  By  compelling 
him  to  lead  a  healthy  life  and  depriving  him 
of  the  alcohol  we  will  cure  him."  But  does  it 
cure  him  ?  With  regard  to  this  class  of  alcoholics 
the  answer  must  be  in  the  negative — it  cannot 
very  well  be  otherwise.  Wliat  in  all  this  is  going 
to  remove  the  craving,  which  is  a  pathological 
factor  and  cannot  be  removed  by  any  regulation 
of  habits  or  diet  ?  The  patient  enters  the  home 
with  a  craving  for  alcohol ;  he  leaves  it  with  a 
craving  for  alcohol,  and  whether  he  is  two  or 
seven  years  imprisoned  makes  no  difference. 
Why  seven  years  I  do  not  know,  but  it  may 
have  some  reference  to  the  popular  belief  that 
once  every  seven  years  the  whole  body  is  renew^ed, 
and  it  may  be  hoped  that  a  new  body  will  be 
free  from  the  craving.  Personally  I  do  not 
believe  that  seven  times  seven  years  would 
remove  a  genuine  craving.  Now  let  us  see 
what  really  does  happen.  By  their  own  reports 
the  percentage  of  cures  is  a  small  one.  These 
reports  include  all  classes  of  alcoholics  ;  quite 
a  large  percentage  will  come  under  other  divisions 
of  alcoholism — therefore  not  concerned  with  the 
present  question.  Out  of  the  remainder  I 
doubt  whether  one  is  ever  cured.  I  have  met 
several    thousands    of    these    patients,    and    so 


TREATMENT  171 

far  have  not  been  able  to  find  one  undoubted 
cure.  I  am  using  the  term  "  cure  "  in  its  strictest 
sense,  meaning  by  the  term  that  the  patient 
lias  been  entirely  freed  from  his  craving  for 
drink.  The  effect  of  this  sort  of  treatment 
upon  patients  varies  very  much  according  to 
the  home,  the  patient,  the  method  of  his  entering, 
the  reason  of  his  detention,  or  a  combination  of 
some  or  all  of  these  factors.  As  to  the  method 
of  entering,  when  one  considers  what  a  young 
man  is  signing  away  in  agreeing  to  enter  a 
restraint  home,  one  might  wonder  how  the 
managers  of  such  homes  obtain  sufficient  patients 
to  enable  them  to  pay  expenses  ;  but  it  is  often  a 
case  of  "  have  to  "  in  order  to  escape  the  conse- 
quences of  some  folly  committed  during  a  recent 
fit  of  drinking,  or  pressure  brought  to  bear 
upon  them  in  some  other  direction  ;  or  they 
may  be  in  a  very  penitential  mood  when  they 
are  willing  to  agree  to  enter.  Very  few  enter 
with  a  determination  to  get  cured  if  possible, 
and  none  of  them  expect  to  be  there  beyond 
the  shortest  possible  period. 

Having  got  our  patient  to  sign  away  his 
liberty  and  enter  a  home,  the  next  factor  which 
will  affect  him  will  be  the  character  of  the  home — 
the  impression  of  the  building,  the  grounds,  the 
rooms    provided     for    patients,     the    classes    of 


172  MODERN  TREATMENT  OF  ALCOHOLISM 

patients  met  with,  the  service,  the  food,  the 
means  of  recreation,  the  staff ;  in  fact,  all  that 
goes  to  make  living  away  from  home  possible. 
That  homes  differ  widely  in  these  respects  is 
well  known  ;  the  best  of  them  are  but  prisons, 
while  some  of  them  are  far  worse  than  any 
prison.  I  was  once  induced  to  visit  a  home 
by  an  agent  who  wished  to  sell  the  place  to  me. 
I  shall  never  forget  the  impression  the  home 
made  upon  me.  The  whole  place  was  gloomy 
and  depressing  in  an  extreme  degree.  I  was 
glad  to  hurry  through  it  and  shorten  my  visit 
as  much  as  possible,  and  I  experienced  a  distinct 
feeling  of  relief  when  I  stood  once  more  in  the 
roadway.  I  saw  a  dozen  men  in  a  dismal,  shabby 
room,  looking  very  much  like  their  dilapidated 
surroundings.  The  effect  upon  these  men  can 
readily  be  imagined.  I  feel  quite  convinced  that 
a  week  in  such  a  place  would  drive  most  men 
to  drink.  At  another  place  I  visited,  the  interior 
arrangements  were  much  better,  but  the  building 
and  grounds  were  cheerless  and  depressing.  At 
another  place  nature  had  provided  a  charming 
view  and  even  bracing  air,  but  in  all  other  respects 
the  place  was  most  depressing,  and  again  I  was 
glad  to  have  the  keys  turned  in  the  lock  of  the 
gate  behind  me  as  I  left  the  place.  If  these 
places    were    intended    to    punish    the    inmates 


TREATMENT  173 

they  could  not  be  better  fitted  for  the  purpose  ; 
but  their  object  is  to  reclaim,  to  elevate,  to 
re-model,  to  encourage,  to  inspire  hope,  etc. 
The  lives  of  the  patients  are  to  be  brightened, 
their  hopes  raised — can  any  one  imagine  success 
under  such  conditions  ?  Having  got  our  man 
to  sign  away  his  liberty  and  enter  one  of  these 
homes,  he  soon  realises  what  an  awful  mistake 
he  has  made.  The  temporary  condition  of  mind 
which  made  it  possible  to  obtain  his  signature  has 
passed  away,  and  he  now  resents  the  advantage 
that  was  taken  of  his  condition,  while  he  still 
more  resents  the  fact  that  he  is  a  prisoner — 
as  much  so  as  any  one  in  Portland  ;  for  if  he 
leaves  the  confines  of  his  prison  he  is  liable 
to  arrest  and  return  by  the  first  police  officer  he 
meets.  Resentment  and  bitterness  soon  fill  his 
mind,  and  ere  long  revenge  is  added.  He  only 
awaits  his  release  to  show  what  he  thinks  of  such 
treatment.  Having  felt  that  he  has  been  tricked 
into  signing  away  his  personal  liberty,  he  now 
feels  that  he  is  being  unjustly  detained.  His 
resentment  grows  rapidly  with  time. 

If  we  review  the  question  of  this  method  of 
treatment  upon  this  class  of  patients,  we  will 
easily  see  why  it  is  a  failure  and  why  it  must  always 
be  a  failure.  In  the  first  place,  the  patient  has 
a  disease  characterised  by  a  craving  due  to  a 


174  MODERN  TREATMENT  OF  ALCOHOLISM 

pathological  condition  of  his  nerve  cells.  Now 
it  stands  to  reason  that  no  amount  of  punishment 
will  cure  this  condition.  The  other  factor  is 
his  inability  to  obtain  a  supply  of  alcohol.  We 
will  suppose  that  he  really  cannot  get  a  supply  ; 
he  is  not  much  better  off  on  that  accoimt.  It 
is  quite  true  that  he  is  not  indulging  his  craving, 
but  this  is  far  outweighed  by  the  adverse  factors. 
He  is  also  supposed  to  improve  in  physical 
health  through  enforced  regular  habits.  This 
may  be  true  with  regard  to  the  best  class  of 
homes,  where  the  comfort  of  the  patients  is 
made  the  first  consideration  and  the  question 
of  profit  takes  a  secondary  place,  but  in  all  others 
the  depressing  surroundings  of  the  patients 
must  greatly,  if  not  entirely,  offset  this.  But 
as  we  wish  to  be  perfectly  fair,  in  order  to  do  so 
we  will  send  our  patient  to  one  of  the  very  best 
homes  in  England  and  note  the  effect.  We 
succeed,  after  considerable  searching,  in  finding 
a  home  with  bright  surroundings  and  every 
possible  comfort  for  the  patient.  W^e  are  in- 
formed by  the  officer  in  charge  that  the  patient 
must  agree  to  remain  for  a  period  of  several 
years.  The  terms  are  high,  but  as  we  are  anxious 
to  reclaim  the  patient  we  do  not  object  to  this. 
Now  let  us  watch  the  effect  upon  our  patient  of 
this  beautiful  home   and  its  surroundings.     We 


TREATMENT  175 

must  not  forget  that  this  patient  of  ours  has 
a  physical  disease  which,  as  I  have  already 
shown,  is  not  influenced  by  this  method  of 
treatment.  One  of  three  results  will  follow : 
either  he  will  make  a  manly  resolution  to  get  all 
the  benefit  he  can  out  of  his  stay  at  the  home,  or 
he  will  nurse  his  revenge  till  freed,  or  he  will 
lose  all  hope  and  join  the  ranks  of  the  ne'er-do- 
weel's  with  whom  he  is  compelled  to  consort 
daily.  The  first  of  these  results  is  the  least 
likely  to  happen.  With  regard  to  the  second 
result,  I  may  quote  one  or  two  cases  in  illustra- 
tion of  this.  The  first  was  a  young  man  about 
twenty-five  years  old.  He  had  been  confined 
in  one  of  our  best-known  homes  for  two  years. 
When  he  regained  his  liberty  he  went  to  the 
nearest  inn  and  got  gloriously  full,  with  the  one 
object  of  revenging  himself  upon  those  who  had 
sent  him  to  the  home.  Here  is  a  case  of  a  man 
who  lost  two  years  out  of  his  life,  with  the  only 
result  of  causing  hard  feeling  towards  those 
who  had  placed  him  there.  When  I  first  saw 
this  patient  he  was  very  ill  in  bed  from  the 
effects  of  a  prolonged  spree.  When  he  had 
sufficiently  recovered  from  this  to  travel,  he  was 
sent  to  me  for  treatment.  I  did  not  find  it 
necessary  to  restrict  his  liberty  for  a  single  day, 
and   instead    of   having    to   waste    another    two 


176  MODERN  TREATMENT  OF  ALCOHOLISM 

years  he  left  my  care  at  the  end  of  six  weeks. 
He  is  now,  and  has  been  ever  since  his  treatment, 
one  of  the  busiest  men  in  London.  He  was 
treated  seven  years  ago,  but  has  never  relapsed. 
He  has  entire  charge  of  very  large  and  important 
works — a  position  which  he  would  not  hold  for 
twenty-four  hours  if  he  resorted  to  his  old  habits. 
Another  case  was  that  of  a  gentleman  who 
during  an  attack  of  drinking  signed  papers  and 
was  safely  shut  up  in  a  home.  The  next  day,  on 
realising  what  he  had  done,  he  demanded  to  be  set 
at  liberty,  and  when  this  was  refused  he  took  a 
large  pocket-knife  from  his  pocket  and  threatened 
to  kill  himself  if  he  was  not  set  at  liberty  at  once. 
That  he  meant  what  he  said  was  evident  from 
the  fact  that  he  was  released  immediately.  This 
was  one  of  our  best  homes,  and  from  an  outsider's 
point  of  view  a  most  charming  place.  I  knew 
the  medical  superintendent  well,  and  there  was 
nothing  about  the  home  or  its  management  with 
which  the  patient  could  find  fault.  It  was  simply 
the  fact  that  the  patient,  as  soon  as  he  sobered 
up,  knew  that  his  disease  was  one  in  which  there 
was  no  need  for  imprisonment,  and  he  resented 
his  incarceration  in  the  only  way  possible  to 
him.  On  going  home  his  friends  told  him  that 
something  ought  to  be  done,  and  he  quite  agreed 
with  them,  saying,  "I  need  a  doctor,  not  a  jailer"; 


TREATMENT  177 

and  when  informed  that  he  could  enter  a  home 
for  treatment  where  he  could  enjoy  his  personal 
liberty,  he  readily  consented  to  go.  How  I 
came  to  know  the  story  of  his  visit  to  the  other 
home  was  as  follows — almost  the  first  thing 
he  asked  me  was  permission  to  go  over  the 
place.  After  he  had  done  so  he  said,  "  You 
will  wonder  why  I  did  that,"  and  he  then  told 
me  his  history.  This  patient  knew  what  he 
required  better  than  the  doctor  who  wished  to 
lock  him  up.  I  never  had  a  moment's  trouble 
with  him,  and  he  made  an  excellent  cure. 

Now  it  is  quite  evident  that  in  both  of  these 
cases  the  patient  knew  what  was  needed  while 
the  doctor  and  the  friends  did  not.  One  might 
go  on  quoting  such  cases  by  the  hundred,  but 
these  two  will  do  just  as  well  as  a  hundred  to 
show  that  in  this  class  of  patients  the  prison 
system  is  not  only  useless  but  harmful. 

What  applies  to  the  constant  drinker  apphes 

equally  to  the  periodical  drinker.     We  cannot  take 

time  here  quoting  cases  for  tliis  class,  of  a  similar 

nature  to  the  above.     It  is  in  the  three  remaining 

classes  of  alcoholism  that  treatment  by  restraint 

is  likely  to  be  of  service,  namely,  in  dipsomania, 

voluntary    drinking,    and    drug-taking.     In    the 

voluntary  drinker  there  is  nothing  to  treat  by 

restraint  ;  here  it  is  simply  a  question  of  morals, 
12 


178  MODERN  TREATMENT  OF  ALCOHOLISM 

and  no  one  nowadays  believes  that  restraint  has 
a  beneficial  effect  upon  morals.  It  is  possible 
that  in  some  cases  it  may  act  as  a  punishment 
with  a  beneficial  effect,  but  the  number  of  cases 
in  which  it  would  so  act  would  be  far  outnumbered 
by  the  cases  in  which  it  would  act  in  a  demoral- 
ising way.  It  is  therefore  not  safe  to  put  a 
voluntary  drinker  into  a  home.  The  risk  of 
harm  is  far  greater  than  the  possible  benefit. 

Then  there  is  the  drug-taker.  Restraint  is 
useful  in  these  cases,  and  here  it  has  a  legitimate 
use,  and  in  many  cases  is  essential,  but  not  in  all, 
as  I  shall  show  later  on. 

The  one  class  of  inebriate  for  whom  restraint 
is  not  only  useful  but  essential  is  the  dipsomaniac  ; 
here  it  is  absolutely  necessary  in  many  cases 
to  use  restraint,  not  only  as  a  method  of  treat- 
ment but  also  as  a  precaution,  for  the  danger 
to  life  from  many  of  these  patients  is  greater 
than  is  generally  believed.  It  is  my  opinion 
that  every  dipsomaniac  should  be  placed  under 
restraint  while  being  treated.  That  some  of 
these  patients  may  be  treated  successfully 
wdthout  restraint  I  know,  as  I  have  so  treated 
some  cases  myself,  but  when  one  has  had  several 
narrow  escapes  from  death  at  the  hands  of  these 
gentlemen  one  is  likely  to  change  his  opinion 
as  well  as  his  method  of  treatment.     My   advice 


TREATMENT  179 

to  every  general  practitioner  wlio  may  have  a  case 
of  this  kind  is  to  get  the  patient  into  a  home  as 
soon  as  possible,  and  keep  him  there  as  long 
as  possible.  The  treatment  of  these  patients 
outside  a  home  is  not  often  satisfactory,  and  may 
be  dangerous  to  the  man  in  charge. 

Treatment  by  restraint  may  be  said  to  be  useful 
in  drug  cases,  essential  in  dipsomania,  of  little 
use  in  voluntary  cases,  and  positively  harmful 
in  daily  alcoholics. 

Having  now  studied  the  question  as  to  what 
cases  are  and  what  are  not  benefited  by  restraint, 
we  are  in  a  position  to  judge  as  to  the  probable 
benefit  or  otherwise  of  imprisonment  of  alcoholics, 
and  to  see  what  a  farce  it  is  to  fill  our  jails  with 
these  patients.  If  it  were  only  a  question  of 
wasting  the  money  it  would  be  bad  enough,  but 
when  one  thinks  of  the  enormous  harm  done 
to  these  alcoholics,  one  wonders  what  our  law- 
givers are  about  that  such  a  condition  of  things 
is  not  changed. 

Turn  one-half  the  money  used  in  keeping 
these  poor  patients  in  prison  to  use  in  con- 
structing and  maintaining  proper  homes  for 
the  treatment  of  such  cases,  and  the  question 
of  alcoholism  would  soon  be  a  minor  one.  I 
consider  our  law  in  regard  to  these  cases  as 
antiquated  and  unscientific,  and  if  I  were  Home 


i8o  MODERN  TREATMENT  OF  ALCOHOLISM 

Secretary  and  had  sufficient  power  I  would 
issue  an  order  to  discharge  every  one  imprisoned 
for  alcohohsm,  and  would  not  rest  until  I  had 
the  present  law  repealed  and  a  sane  one  in  its 
place.  Imprisonment  for  alcoholism  alone  is  a 
reflection  on  the  sanity  of  the  nation.  I  do  not 
expect  many  outside  the  medical  profession  to 
agree  with  me  in  this,  as  the  scientific  grasp  of 
the  whole  question  of  alcoholism  is  of  such 
recent  date  that  they  are  not  yet  able  to  under- 
stand it.  We  have  heard  of  our  forefathers 
burning  innocent  women  and  children  for  witchery 
and  of  hanging  men  for  stealing  sheep  ;  I  consider 
our  present  laws  on  alcoholism  quite  as  much  out 
of  place  on  the  Statute  Book  as  they  were,  and  the 
sooner  they  are  off  the  better  for  all  concerned. 

The  Treatment  of  Alcoholism  by  Diet 

We  now  come  to  the  question  of  treatment 
by  diet.  This  term  covers  a  number  of  divisions, 
and  each  will  repay  a  careful  study  by  those 
interested  in  the  question  of  the  treatment  of 
alcoholism.  The  treatment  of  alcoholism  by  diet 
is  understood  to  mean  one  thing  by  one  person 
and  another  by  another  person.  To  the  Nor- 
wegian it  means  saturation  of  the  food  with 
alcohol,   to   the   vegetarian   it   means   a   strictly 


TREATMENT  181 

vegetable  diet,  the  meat  diet  advocate  believes 
in  a  strictly  meat  diet  ;  then  there  are  numerous 
adherents  of  the  fruit  diet  in  its  many  divisions, 
namely,  the  orange,  the  lemon,  the  apple,  the  pear, 
the  raisin,  the  grape,  the  water-melon,  and  the 
combination  fruit  diet  cure.  To  others  it  may 
mean  generous  diet  ;  to  others  again  it  means  a 
diet  minus  pepper,  mustard,  and  all  such  condi- 
ments. Then  others  believe  in  a  salt  cure.  In 
fact  it  is  difficult  to  enumerate  the  complete 
list  as  it  is  so  lengthy,  but  the  above  will  give 
an  idea  of  the  various  interpretations  placed 
upon  the  term  "diet  treatment."  The  diet 
advocates  certainly  do  not  lack  variety.  A 
glance  at  their  list  reminds  me  of  a  medical  man 
I  met  in  Canada.  He  only  had  one  prescription 
for  all  his  patients,  but  he  had  seventeen  different 
drugs  in  it ;  and  it  seems  to  me  that  this  shot-gun 
mixture  of  his  and  the  varied  choice  afforded 
by  the  diet  people  have  points  in  common.  If 
one  thing  does  not  suit  your  case,  try  another. 
At  the  first  blush  the  whole  thing  appears  nonsense, 
but  in  looking  into  the  question  one  finds  food 
for  reflection  in  every  one  of  the  methods  named. 
Let  us  take  these  in  detail  and  see  what  we 
can  learn  from  them.  The  most  important  of 
these  is  probably  the  Saturation  cure.  The 
saturation  cure  as  used  by  the  Swedish  Govern- 


i82  MODERN  TREATMENT  OF  ALCOHOLISM 

ment  is  not  strictly  a  diet  cure,  but  can  be  classed 
here  as  such  since  it  is  as  much  a  diet  cure  as  a 
drug  cure.  The  cure  consists  of  soaking  the 
patient's  food  in  alcohol  of  some  form  or  another, 
usually  in  that  of  his  favourite  drink.  Every 
particle  of  food  is  thoroughly  soaked  in  this,  and 
no  food  allowed  which  has  not  been  so  treated. 
At  first  the  patient  is  delighted  with  the  method, 
but  in  a  very  short  time  he  finds  it  difficult  to 
eat  the  food  so  prepared,  and  shortly  afterwards 
his  stomach  refuses  it  altogether,  and  the  very 
sight  of  food  so  treated  makes  him  sick.  After 
a  few  days  of  such  treatment  many  are  quite 
unable  to  bear  the  sight  or  smell  of  alcohol,  and 
in  some  cases  it  acts  for  a  considerable  time. 
In  my  opinion  the  treatment  is  absolutely  useless 
in  classes  i,  2,  and  3,  but  might  be  of  service 
in  class  4.  I  have  tested  the  treatment  in  the 
first  three  classes  in  a  manner  which  places  the 
matter  beyond  all  doubt  in  my  own  mind  ;  I 
have  repeatedly  pushed  it  to  such  an  extent  that 
I  kept  the  patient  vomiting  for  two  or  three  days, 
but  although  I  have  tried  it  in  many  cases  I 
have  never  yet  had  a  patient  upon  whom  it 
had  any  effect  for  more  than  a  few  weeks.  I 
have  seen  patients  so  ill  from  its  effects  that  they 
could  not  help  being  sick  for  days  afterwards 
at  the  mere  sight  of  alcohol,  and  take  it  eagerly 


TREATMENT  183 

in  a  fortnight  without  any  apparently  disturb- 
ing effects  upon  them.  Its  effect  is  more  moral 
than  physical.  It  is  sometimes  successful  with 
voluntary  drinkers,  and  while  it  is  of  no  use 
by  itself  in  classes  i,  2,  and  3,  it  is  a  very 
valuable  aid  in  connection  with  some  forms  of 
treatment.     To  this  I  will  refer  later  on. 

The  Vegetable  Diet  cure  is  strongly  believed 
in  by  those  who  believe  that  meat  is  the  root 
of  all  evil.  Vegetarianism  concerns  us  only  in 
so  far  as  it  affects  the  question  of  alcoholism. 
It  is  one  of  those  things  which  suits  some  people 
and  not  others.  If  it  suits  an  alcoholic  patient 
to  the  extent  of  improving  his  general  health, 
to  that  extent  it  will  benefit  him  ;  but  this  is 
not  enough  to  justify  one  in  terming  it  a  cure 
for  alcohohsm.  It  is  likely  to  prove  of  help 
in  those  cases  where  the  patient  is  consuming 
an  undue  amount  of  meat  and  taking  an  insuffi- 
cient amount  of  exercise  ;  the  waste  products 
that  accumulate  in  the  body  frequently  produce 
a  great  amount  of  depression.  This  in  an 
alcoholic  may  be  depressing  him  sufficiently  to 
cause  him  to  drink  to  excess.  In  such  a  case 
a  change  to  a  vegetable  diet  may  be  successful 
in  curing  him  for  the  time  being.  Although 
vegetarianism  is  not  a  cure  for  alcoholism  in 
itself,  yet  we  will  often  find  it  useful  in  the  general 


i84  MODERN  TREATMENT  OF  ALCOHOLISM 

treatment  of  alcoholic  patients.  That  it  is  not 
a  cure  is  further  made  manifest  when  one  sees 
vegetarians  who  are  as  confirmed  inebriates 
as  any  meat  eaters. 

Again,  we  have  those  who  pin  their  faith  to  the 
very  opposite,  namely,  a  meat  diet.  They  claim 
that  it  is  possible  to  cure  alcoholics  by  feeding 
them  on  an  exclusively  meat  diet.  Here  we 
have  another  apparent  contradiction,  yet  while  it 
is  not  a  cure  in  itself  it  is  capable  of  being  of  the 
greatest  help  in  certain  conditions.  Just  as  an 
exclusively  meat  diet  is  useful  in  certain  forms 
of  dyspepsia,  so  it  is  useful  in  treating  alcoliolics 
whose  attacks  are  due  to  this  particular  form  of 
dyspepsia ;  cure  the  dyspepsia  and  you  cure 
the  attacks.  This  is  also  useful  in  general 
treatment  at  times. 

We  now  come  to  the  question  of  the  treatment 
of  alcoholism  by  means  of  fruit.  Let  me  refresh 
your  memory  with  a  list  of  fruit  used  by  advocates 
of  this  method  ;  it  includes  oranges,  lemons, 
apples,  grapes,  raisins,  and  water-melons.  There 
are  three  factors  common  to  most  of  this  group, 
namely,  the  acidity,  the  sugar,  and  their  cathartic 
action.  The  latter  is  practically  the  most 
important  of  these.  As  1  have  stated  before, 
some  men  begin  their  drinking  because  their 
system  is  loaded  with  waste  products,  causing 


TREATMENT  185 

depression  ;  the  fruit  relieves  this  and  the  need 
for  alcohol  at  the  same  time.  With  regard 
to  the  acid  fruits,  we  know  that  the  citric  acid 
of  the  lemons  and  oranges  has  a  cooling  effect 
upon  the  blood,  and  in  some  people  of  a  hot- 
blooded  nature  this  may  be  successful  in  prevent- 
ing outbreaks  of  drinking.  There  can  be  no  doubt 
that  many  drinking  men  find  both  oranges  and 
lemons  of  great  help  in  their  battle  against 
alcohol.  I  have  known  men  who  have  eaten 
oranges  every  morning  for  years,  and  who  felt 
quite  convinced  that  it  helped  them  greatly. 
Others  again  when  sobering  up  consume  great 
numbers  of  oranges  or  lemons,  and  seem  to  find 
them  of  great  assistance.  The  effect  of  lemons 
when  sobering  up  is  well  shown  in  the  following 
incident :  One  of  my  patients  had  had  a  severe 
attack  of  delirium  tremens,  and  was  left  with  a 
hard,  dry,  furred  tongue  ;  one  of  those  tongues 
which  look  and  feel  like  a  piece  of  old  burnt 
leather — you  feel  half-afraid  to  take  hold  of  it 
for  fear  it  will  break  in  your  hands — what  is 
known  in  the  medical  profession  as  "an  extreme 
typhoid  tongue."  I  had  used  all  my  usual 
remedies  without  any  marked  gain,  and  the 
persistence  of  this  condition,  together  with  the 
accompanying  symptoms,  caused  me  considerable 
concern.     A  patient  who  had  been  a  hard  drinker 


i86  MODERN  TREATMENT  OF  ALCOHOLISM 

in  his  time  offered  to  cure  him  in  a  few  hours  if 
I  would  let  him.  I  gladly  availed  myself  of  his 
riper  experience.  He  made  a  large  jugful  of 
strong  lemonade,  and  sitting  at  the  patient's 
side  steadily  fed  him  with  this.  When  I  saw 
the  patient  two  hours  later  I  could  hardly  credit 
what  I  saw.  The  look  of  strained  anxiety 
was  replaced  by  one  of  great  relief,  and  there 
was  a  remarkable  improvement  in  the  pulse  ;  the 
tongue  was  cleared  almost  beyond  belief,  and  the 
patient  was  asking  for  food.  On  expressing 
my  thanks  to  the  old  hand  for  his  valuable 
help,  he  told  me  that  he  had  used  it  in  many 
cases  and  always  with  entire  success.  I  have 
used  it  in  numerous  cases  since,  with  the  greatest 
benefit  to  the  patient.  If  lemons  can  be  of 
such  service  in  these  cases,  it  is  only  reasonable 
to  assume  that  in  minor  cases  of  alcoholism 
they  may  be  of  service  in  preventing  an  outbreak 
of  drinking.  What  applies  to  lemons  applies 
also  to  oranges  in  a  lesser  degree.  Before 
leaving  the  question  of  lemons  I  ought  to  say 
that  lemons  are  not  without  danger,  as  the 
following  will  show.  While  penning  these  lines 
an  American  gentleman  consulted  me  with 
regard  to  his  health.  I  found  that  he  had 
chronic  bronchitis  with  heart  complications. 
He  suffered  greatly   from  cold   feet  and  hands, 


TREATMENT  187 

always  feeling  chilly.  I  learned  from  his  wife 
that  he  was  very  fond  of  a  glass  of  lemonade, 
and  took  one  every  night.  As  this  was  strongly 
contra-indicated  by  his  condition  I  got  him 
to  leave  it  off  for  a  short  time,  but  one  night 
after  being  in  the  City  all  day  he  decided  to 
try  it  again  and  drank  a  jugful  of  it,  and  as 
usual  followed  it  by  a  warm  bath  ;  while  drying 
himself  he  died  suddenly.  I  had  advised  him 
to  go  to  Algiers  for  the  winter,  and  he  had  bought 
his  ticket.  After  closely  investigating  the  circum- 
stances, I  could  come  to  no  other  conclusion 
than  that  he  had  died  from  the  effects  of  the 
lemonade. 

The  Grape  Cure. — The  advocates  of  this 
method  of  treating  disease  claim  to  have  obtained 
some  remarkable  results.  I  have  no  personal 
knowledge  of  it,  but  think  it  likely  to  aid  the 
alcoholic  mainly  by  its  effects  upon  the  general 
health.  I  had  a  large  number  of  vines  at  one  of 
my  sanatoria,  and  allowed  the  patients  to  eat 
freely  of  the  grapes  when  in  season,  but  beyond 
the  general  effect  of  fruit  already  mentioned 
I  did  not  notice  any  particular  effect.  I  think 
it  likely  w^e  should  have  heard  more  of  the  subject 
if  there  was  any  specific  benefit  derived  from 
the  use  of  the  fruit . 

The  Raisin  Cure. — The  well-known  effects  of 


i88  MODERN  TREATMENT  OF  ALCOHOLISM 

this  fruit  upon  the  system  may  account  for  its 
place  in  the  Hst  of  remedies.  The  sugar  may 
have  some  effect  also,  for  from  some  reason  yet 
unexplained  to  physiologists  sugar  plays  a  large 
part  in  the  drama  of  drinking,  to  which  I  have 
already  referred. 

Water-melons. — In  America  many  men  can 
resist  the  craving  for  alcohol  if  they  can  obtain 
plenty  of  water-melons.  Here  we  have  added 
the  important  item  of  water,  and  have  three 
factors  at  work  helping  the  alcoholic  ;  he  has  a 
substitute  for  alcohol  in  the  large  quantity  of 
sugar,  the  pulp  of  the  melon  with  its  cathartic 
effect,  and  the  water  with  its  flushing  effect  ; 
these  might  well  help  a  man  whose  drinking 
was  caused  by  nerve  irritation  due  to  an  excess 
of  toxins  in  the  system. 

The  combined  fruit  treatment  is  largely  a 
combination  of  the  preceding.  As  a  great 
many  men  resort  to  alcohol  owing  to  an  irritable 
condition  of  the  nerves  caused  by  an  excess  of 
toxins  in  the  system,  it  is  quite  conceivable 
that  they  may  find  sufficient  help  in  the  use 
of  the  fruit  to  enable  them  to  resist  the  craving 
for  alcohol.  Anything  which  will  clear  the 
system  of  toxins  will  help  them  ;  therefore  fruit 
affords  them  an  ideal  combination.  One  does  not 
wonder  that  it  is  a  great  favourite  with  alcoholics. 


TREATMENT  189 

The  Generous  Diet  Cure. — It  seems  a  simple 
thing  to  say,  "  Fill  a  man's  stomach  and  he  will 
not  drink  to  excess."  If  that  was  all  we  had 
to  do,  the  treatment  of  alcoholism  would  be  an 
easy  matter.  Unfortunately  it  is  not  a  cure, 
but,  like  the  above  remedies,  only  a  help.  That 
a  man  is  less  likely  to  drink  on  a  full  stomach 
than  on  an  empty  one  is  quite  true,  but  to  look 
upon  this  as  a  cure  is  quite  another  matter. 
It  is  also  quite  true  that  with  certain  men  a 
generous  diet  is  quite  sufficient  to  keep  them  off 
the  drink.  In  this  as  in  all  other  methods  there 
may  be  found  help,  but  not  a  cure.  That  a 
man  with  a  full  stomach  will  have  less  craving 
for  alcohol  is  easily  understood,  but  to  expect 
food  alone  to  satisfy  an  alcoholic  craving  is  to 
plead  entire  ignorance  of  the  whole  subject. 
The  intention  of  a  large  number  of  those  would- 
be  doctors  is  of  the  kindest,  and  in  very  mild 
cases  their  treatment  may  be  of  some  use,  but 
when  they  attempt  to  stay  the  craving  of  con- 
firmed alcoholism  by  such  means  they  are  like 
a  man  trying  to  resist  the  tide  with  a  broom. 
If  their  good  intentions  ended  merely  in  failure 
it  would  not  matter  so  much,  but  unfortunately 
this  is  not  the  case.  The  results  of  their  efforts 
are  more  far-reaching  than  this,  for  by  their 
failure    to    cure    they    discourage    the    patient 


igo  MODERN  TREATMENT  OF  ALCOHOLISM 

and  cause  him  to  take  an  unnecessarily  gloomy 
view  of  his  case,  and  in  some  cases  only  prevent 
him  from  making  further  efforts  towards  a  cure. 
That  good  feeding  is  an  essential  in  the  treat- 
ment of  alcohohsm  goes  without  saying,  but  it 
must  take  its  proper  place  in  the  treatment 
and  not  be  put  forward  as  a  cure. 


The  Treatment  of  Alcoholism  by  Drugs 

Before  proceeding  to  detail  the  actual  method  of 
treatment  by  drugs,  I  would  hke  to  say  a  few  words 
about  the  history  of  the  movement  in  this  country. 
One  is  quite  accustomed  now  to  hear  of  a  patient 
going  away  for  six  weeks  and  returning  cured  of 
his  alcohohsm  ;  but  that  is  of  very  recent  date. 
One  did  not  hear  of  it,  say,  ten  years  ago — or  at 
least  very  seldom.  Ten  years  ago  any  advocate 
of  the  short  term  or  drug  treatment  for  alcoholism 
was  more  often  laughed  at  than  hstened  to.  When 
I  founded  the  Norwood  Sanatorium  my  greatest 
difficulty  was  in  persuading  the  profession  that 
there  was  anything  in  the  treatment  of  alcohohsm 
by  means  of  drugs.  One  easily  remembers  the 
incredulous  smile  with  which  one's  statements 
were  received.  One  reads  of  our  insular  prejudice, 
but  to  realise  it  it  is  necessary  that  one  should  be  a 
social  reformer  in  some  direction  ;   then,  and  only 


TREATMENT  191 

then,  can  one  get  the  faintest  idea  of  its  vastness 
and  its  sohd  stupidity.  I  no  longer  wonder  that 
the  French  shrug  their  shoulders  at  us  in  despair. 
But,  like  every  other  truth,  this  treatment  had  to 
prevail  in  the  end.  When  I  opened  the  Norwood 
Sanatorium  patients  came  to  me  in  spite  of  the 
doctors — not  on  account  of  them.  Some  were 
told  by  their  doctors  that  all  sorts  of  harm  would 
befall  them  it  they  took  the  treatment ;  not  one 
but  several  were  told  they  might  consider  them- 
selves lucky  if  they  returned  alive.  Others  were 
told  that  the  treatment  would  affect  their  heart  in 
various  ways.  Others,  that  their  mind  was  in 
danger.  In  the  denseness  of  their  ignorance  of  the 
whole  question  a  certain  section  of  the  profession 
carried  their  opposition  to  an  extent  that  was 
actual  persecution.  Nevertheless,  patients  pre- 
sented themselves  for  treatment,  were  cured,  and 
reported  themselves  to  their  doctors  on  their 
return  home.  Thus  was  the  truth  greatly  mani- 
fested. To  show  to  what  an  extent  a  prejudiced 
person  may  sometimes  go  rather  than  relinquish 
his  prejudices,  the  following  incident  will  serve. 
A  patient  entered  the  sanatorium  with  a  history 
of  daily  drinking  to  excess  covering  a  period  of 
several  years.  His  failing  was  known  to  all  the 
villagers,  as  he  might  be  seen  any  day  reeling  about 
the  streets.     He  informed  me  that  his  doctor  had 


192  MODERN  TREATMENT  OF  ALCOHOLISM 

done  all  he  could  to  prevent  him  coming,  and 
prophesied  that  he  would  return  in  his  cofhn. 
When  he  returned  home  not  only  alive  but  sober, 
this  doctor  made  a  bet  that  he  would  be  drinking 
again  inside  of  a  week  ;  losing  this  bet  he  made 
another — that  the  patient  would  be  drinking  within 
a  month  ;  when  he  lost  this  also  he  made  a  still 
further  one — that  he  would  relapse  inside  of  three 
months.  On  losing  this  bet,  in  order  to  prove  that 
his  opinion  was  correct,  he  resorted  to  a  trick  of 
such  a  dastardly  nature  that  without  the  fullest 
proof  I  could  not  credit  it  of  any  member  of  our 
profession.  Noticing  that  his  former  patient  had 
a  slight  cough,  he  called  him  into  his  surgery  and 
made  him  up  a  cough  mixture — or  at  least  a 
mixture  purporting  to  be  one.  This  mixture 
contained  principally  alcohol  disguised.  On  the 
patient  attempting  to  take  it  he  vomited  freely, 
telling  his  wife  that  there  must  be  something  wrong 
about  it.  But  his  wife  told  him  that  some  cough 
mixtures  were  intended  to  make  one  sick — so  he 
took  it  again,  with  a  similar  result.  On  asking  the 
doctor  for  an  explanation,  the  doctor  only  laughed, 
but  admitted  later  on  what  he  had  done.  Here  is 
a  case  of  a  man  engaged  in  one  of  the  noblest  pro- 
fessions risking  this  man's  whole  career  rather 
than  give  up  his  prejudice.  Although  this 
happened  fifteen  vears  ago,  I  am  glad  to  be  able  to 


TREATMENT  193 

say  that  the  patient  has  never  relapsed  and  has 
held  an  important  position  all  that  time.  Could 
prejudice  go  further  than  this  ?  I  think  not. 
Truth  generally  triumphs  in  the  end,  and  now  we 
find  the  treatment  which  was  laughed  at  a  few 
years  ago  given  the  foremost  place. 

Leaving  the  question  of  the  history,  let  us 
describe  the  treatment  itself.  The  first  duty  of 
the  doctor  is  to  make  a  diagnosis.  I  do  not  mean 
by  this  that  the  doctor  should  decide  whether  or 
not  the  patient  drinks  to  excess,  although  that 
will  be  also  necessary,  for  all  patients  brought 
to  a  home  are  not  necessarily  alcoholics  ;  but  by 
careful  investigation  of  the  history  not  only  to 
decide  that  he  is  an  alcoholic,  but  to  place  him 
in  his  proper  class.  Until  this  is  done,  no  real 
progress  can  be  made.  I  wish  to  emphasise 
this  point  strongly  ;  it  is  not  enough  to  say, 
*'  Yes,  the  man  is  a  drunkard,"  and  put  him 
under  treatment.  It  would  be  just  as  wise  to 
administer  a  febrifuge  to  all  patients  with  a  rise 
in  temperature,  without  ascertaining  the  cause 
of  the  fever,  as  to  treat  an  alcoholic  simply  on 
the  fact  that  he  drinks  to  excess.  The  battle 
is  won  or  lost  at  the  very  beginning  of  the 
case,  and  any  time  spent  in  a  careful  diagnosis 
will  be  well  rewarded  in  the  results  obtained. 
The  examination  having  placed  him  in  his 
13 


194  MODERN  TREATMENT  OF  ALCOHOLISM 

proper  class,  we  have  to  carefully  ascertain 
what  are  the  individual  characteristics  of  his 
case.  These  three  inquiries  are  of  increasing 
importance  from  the  first  to  the  last.  Is  the 
patient  an  alcoholic  ?  There  are  some  who  will 
think  this  an  unnecessary  question,  seeing 
that  his  friends  have  brought  him  for  treatment. 
This  does  not  necessarily  follow  ;  friends  may 
be  mistaken,  as  we  sometimes  find  to  be  the 
case,  for  it  must  be  remembered  that  all  men 
who  drink  to  excess  are  not  alcoholics.  I  have 
sometimes  found  the  patient  himself  to  be 
mistaken  on  this  point,  and  if  this  is  possible 
for  the  patient,  it  is  fair  to  assume  that  his  friends 
may  be  mistaken  also.  How  are  we  to  ascertain 
that  he  is  an  alcoholic  ?  Before  we  can  do  this 
we  must  have  some  definition  of  what  an  alcoholic 
is.  I  have  adopted  the  foUowing  definition  : 
An  alcoholic  is  one  who  either  continually  or 
at  certain  periods  suffers  from  a  craving  for 
alcohol  or  one  of  its  substitutes.  It  will  be 
apparent  at  once  that  this  definition  does  not 
include  the  class  of  voluntary  drinkers.  The 
main  factor  in  the  disease  is  the  craving  ;  the 
voluntary  drinker  has  no  craving,  consequently 
he  is  not  an  alcoholic.  With  this  definition  as 
a  basis  to  work  upon,  we  can  soon  decide  whether 
or   not   the  patient  is  an    alcoholic.     A  careful 


TREATMENT  195 

inquiry  into  the  history  of  the  patient  will 
generally  enable  us  to  ascertain  whether  there  is 
any  craving  or  not.  If  the  craving  is  entirely 
wanting,  the  case  is  not  one  of  alcoholism.  Let 
me  illustrate  this  by  a  case  or  two.  A  man  was 
brought  to  the  Norwood  Sanatorium  by  a  medical 
man  who  had  had  him  as  a  residential  patient 
for  two  or  three  years.  Owing  to  this  fact,  the 
usual  careful  inquiry  into  his  history  was  omitted. 
A  course  of  treatment  was  administered,  which 
did  him  no  good  whatever.  Here  was  a  medical 
man  who,  having  had  the  patient  in  his  house  for 
two  or  three  years,  assured  me  that  he  was  a 
chronic  alcoholic  from  whom  it  was  impossible 
to  keep  the  drink.  Several  of  his  friends  assured 
me  that  his  case  was  hopeless.  The  patient 
himself  admitted  that  they  were  justified  in  placing 
him  under  restraint.  Later  on  an  inquiry  into 
his  history  showed  that  he  was  not  an  alcoholic 
at  all.  His  drinking  habits  began  with  a  great 
disappointment  in  love.  When  I  had  ascer- 
tained this  I  asked  him  why  he  drank  to  excess — 
his  reply  made  the  whole  diagnosis  quite  clear. 
He  said,  "  What  have  I  to  live  for  ?  My  life  is 
ruined,  and  I  am  a  broken  man.  Give  me  some- 
thing to  live  for,  and  I  will  not  touch  alcohol. 
I  am  a  young  man,  and  I  take  it  to  deaden  my 
feeling."     Here  was  a  healthy  young  man  without 


196  MODERN  TREATMENT  OF  ALCOHOLISM 

the  slightest  craving  who  dehberately  soaked 
himself  with  alcohol  on  every  possible  occasion, 
and  so  far  as  habits  and  appearance  went  was  a 
confirmed  inebriate.  All  treatment  was  wasted 
on  this  patient.  He  found  an  interest  in  life 
and  from  that  moment  became  a  teetotaller. 
This  man  was  never  an  alcoholic,  and  was  not  a 
fit  subject  for  treatment,  because  he  never  had 
a  craving.  The  whole  thing  was  mental,  not 
physical.  Let  us  take  another  case,  and  compare 
it  with  this.  I  had  occasion  to  call  upon  a  friend 
of  mine  at  his  place  in  the  City.  He  invited  me 
to  go  to  a  cafe  where  we  could  discuss  our  busi- 
ness. UHiile  there,  he  ordered  a  whisky-and-soda, 
although  it  was  only  10  o'clock  in  the  forenoon. 
When  I  refused  to  join  him  in  this,  the  conversation 
turned  upon  alcoholism.  I  learned  that  he  was 
accustomed  to  take  several  drinks  of  alcohol, 
beginning  with  one  before  breakfast.  The  object 
of  my  visit  was  to  arrange  for  the  treatment  of  a 
relative  of  his,  and  when  I  told  him  that  if  he 
was  not  careful  he  would  require  treatment 
himself,  he  thought  I  was  joking,  but  thought 
the  joke  a  very  poor  one.  When  he  discovered 
that  I  was  in  earnest,  he  was  very  indignant, 
and  told  me  that  he  was  never  drunk,  that  what 
he  took  never  affected  him  in  any  way,  that  his 
hand  was  as  steady  as  mine  and  his  mind  as  clear. 


TREATMENT  197 

and  that  it  was  absolute  nonsense  to  say  there 
was  anything  in  common  between  him  and  the 
poor  fellow  whom  he  wished  to  place  in  my  charge. 
I  asked  him  to  abstain  for  a  week,  and  if  he  found 
that  he  had  a  craving  for  alcohol,  aside  from  mere 
habit,  he  must  consider  himself  an  alcoholic  ; 
if  not  he  was  still  free.  In  his  eagerness  to  prove 
his  absolute  independence  of  it,  he  offered  to 
abstain  for  a  longer  period.  When  I  next  saw 
him  he  candidly  admitted  that  I  was  quite  right, 
for  on  abstaining  he  found  that  he  had  a  most 
marked  craving  for  alcohol.  His  hand  was  not 
steady,  nor  his  mind  clear  without  it. 

If  we  compare  these  two  cases,  what  do  we  find  ? 
In  the  first  case  was  a  man  who  got  drunk  on 
every  possible  occasion  and  admitted  his  weakness 
readily,  and  was  willing  to  place  himself  under 
restraint  and  treatment ;  yet  he  was  not  an  alco- 
holic. In  the  second  case  we  have  a  man  who 
never  got  drunk,  attended  daily  to  his  work 
with  a  clear  head  and  steady  hand,  and  who 
indignantly  resented  the  very  idea  that  he  was 
an  alcoholic  ;  yet  he  was  an  alcoholic  and  required 
treatment. 

I  think  these  two  cases  will  illustrate  the 
difficulty  one  may  meet  with  in  diagnosing  the 
presence  or  otherwise  of  alcoholism  in  a  patient 
who  drinks  to  excess. 


198  MODERN  TREATMENT  OF  ALCOHOLISM 

Having  diagnosed  a  case  of  alcoholism,  the 
next  most  important  thing  is  to  properly  classify 
it.  If  the  patient  belongs  to  the  first  class 
the  craving  will  be  constant.  By  this  I  do  not 
mean  that  the  craving  will  be  of  a  constantly 
pronounced  type,  nor  need  it  be  always  in  strong 
evidence  to  the  patient  himself  ;  indeed,  it  may 
be  of  such  a  mild  character  at  times  that  the 
patient  may  well  doubt  its  presence.  This 
is  more  likely  to  be  the  case  during  periods 
of  enforced  abstention.  At  such  times  the 
patient  is  very  apt  to  tell  one  that  he  is  entirely 
free  from  all  desire  for  alcohol,  but  if  you  wish 
to  prove  that  this  is  not  the  case  place  temptation 
in  his  way.  In  this  class  of  alcoholics  the  craving 
is  always  present  :  to  prove  this  is  not  an  easy 
matter  in  some  cases,  but  years  of  experience  will 
enable  the  expert  to  do  so  satisfactorily.  As 
the  whole  question  of  classification  and  conse- 
quently of  treatment  hinges  on  this  question  of 
craving,  it  is  of  the  greatest  importance  to  learn 
all  one  may  about  it.  Ask  any  doctor  if  he 
knows  what  this  craving  is,  and  one  of  two 
things  will  happen  :  either  he  will  consider 
the  question  so  elementary  that  it  requires  no 
answer,  or  he  will  tell  you  that  it  means  the 
raging  thirst  which  accompanies  an  outbreak  of 
drinking.     This  is  quite  true,  but  it  is  such  an 


TREATMENT  199 

obvious  fact  that  it  does  not  help  us  in  the 
least ;  a  child  could  tell  us  as  much.  What 
would  be  of  assistance  to  us  in  diagnosis,  and 
essential  to  the  treatment  of  a  case,  is  a  knowledge 
of  how  to  detect  the  presence  of  this  craving 
when  it  is  so  disguised  and  hidden  that  even  the 
patient  himself  does  not  know  of  its  existence. 
This  craving  assumes  so  many  disguises  and 
aspects,  with  so  many  difficult  phases,  that  only 
long  experience  and  careful  investigation  will 
in  many  cases  reveal  it.  The  forms  and  dis- 
guises are  so  numerous  that  it  would  be  im- 
possible to  give  a  list  of  them  in  a  work  of  this 
size.  At  the  same  time  it  will  be  useful  to 
mention  a  few  of  them  in  order  to  indicate  the 
line  of  investigation  necessary.  Lest  the  reader 
wearies  of  this  question  of  craving,  let  me  remind 
him  that  it  is  a  crucial  point  in  both  diagnosis 
and  treatment,  and  that  no  one  will  ever  be  success- 
ful in  curing  these  cases  until  he  has  mastered  it. 
The  grosser  forms  of  it  are  self-evident  and  so 
well  known  that  they  need  not  detain  us  for  a 
moment.  With  regard  to  the  less  obvious 
forms  we  cannot  do  better  than  study  them  early 
in  the  day — before  they  have  been  obliterated 
by  a  further  supply  of  alcohol.  Perhaps  as  good 
a  place  as  any  to  note  their  effects  is  the  smoking- 
room  of   a   passenger  steamer.     One   should  go 


200  MODERN  TREATMENT  OF  ALCOHOLISM 

earty,  as  man}^  of  these  alcoholics  are  poor  sleepers 
and  consequently  are  to  be  found  among  the 
first  in  the  room  ;  those  who  are  able  to  sleep 
can  be  studied  later  on.  Note  the  non-drinker 
as  he  paces  the  deck  filling  his  lungs  with  ozone  ; 
he  is  bubbling  over  with  cheerfulness  and  merri- 
ment. His  very  "  Good  morning  "  is  refreshing, 
and  does  one  good  to  hear  it.  Now  note  the 
greeting  j^ou  get  from  the  man  who  was  so  very 
amiable  the  night  before  !  It  is  possibly  friendly 
enough,  but  it  lacks  all  the  vitalit}^  of  the  former 
greeting.  You  miss  something  at  once.  Later 
on  in  the  day  this  lack  has  disappeared.  This  lack 
may  be  marked,  or  it  may  be  so  slight  as  to 
require  the  trained  eye  to  see  it,  and  there  will 
be  all  degrees  of  it  met  with  in  the  study  of  a 
number  of  cases.  It  is  hardly  necessary  for  me 
to  say  that  one  must  make  due  allowance  for  any 
other  causes  for  this  difference  between  night 
and  morning.  I  would  therefore  say  to  the 
student  of  alcoholism,  take  every  opportunity 
of  studying  the  differences  between  night  and 
morning  in  drinking  men,  and  you  will  soon  be 
able  to  recognise  what  is  meant  by  the  term 
"  craving."  Another  good  place  to  study  it  is 
at  a  protracted  Board  Meeting.  Those  who 
are  alcoholics  will  be  indistinguishable  from  the 
others  at  first,  but   as  time  wears  on   and  the 


TREATMENT  201 

effect  of  the  last  drink  wears  off,  the  difference 
becomes  more  pronounced,  and  the  alcohohc  is 
no  longer  the  man  he  was  when  he  entered  the 
room.  Then  he  was  full  of  fight — now  he  is 
willing  to  give  in  on  all  points  if  that  will  only 
bring  the  meeting  to  a  close,  so  that  he  may 
revive  his  drooping  vitality.  Or,  if  the  matter 
is  too  important  for  him  to  give  in  to  his  opponent, 
his  opposition  takes  the  form  of  a  dogged  and 
unreasonable  attitude  characterised  by  great 
irritation.  Here  also  one  finds  all  degrees  of 
symptoms,  from  the  above  gross  kind  to  that 
delicate  form  which  requires  the  trained  eye  to 
detect.  Another  excellent  place  in  which  to 
study  the  forms  of  craving  is  the  drawing-room. 
There  we  may  study  some  of  its  finer  phases. 
Church  also  supplies  abundant  evidence  of  it, 
and  although  one  tries  to  ignore  it,  unfortunately 
the  trained  eye  will  not  be  denied.  The  theatre 
also  is  a  useful  place  in  which  to  study  the 
question.  But  all  these  places  are  only  capable 
of  showing  the  outward  signs,  and  while  these  are 
useful  in  training,  their  merits  are  few  in  com- 
parison with  the  reading  of  subjective  signs. 
Before  passing  on  to  these  latter,  it  will  be 
advisable  to  mention  some  of  the  more  easily 
noted  objective  signs.  Some  signs  are  common 
to  both  alcoholics  and  users  of  alcohol  who  are 


202  MODERN  TREATMENT  OF  ALCOHOLISM 

not  yet  alcoholics.  It  is  not  worth  while  naming 
all  these  as  they  are  so  well  known.  Those 
of  interest  from  a  diagnostic  point  of  view  are 
as  follows  :  The  w^atery  eye,  the  drooping 
underlip,  the  tuberous  nose,  the  trembling  hand, 
and  the  weak  knees.  Any  one  of  these  taken 
alone  might  be  misleading,  but  a  combination  of 
them  taken  together  with  the  more  obvious 
signs  of  drinking,  is  not  likely  to  mislead  the 
inquirer.  The  well-known  watery  eye  is  not 
easily  mistaken  for  anything  else.  The  drooping 
underlip  should  be  looked  for  when  the  patient 
is  reading,  and  excepting  in  the  very  old  and 
feeble  is,  when  found,  very  diagnostic.  When 
the  patient's  facial  muscles  are  relaxed  the 
lower  lip  will  droop  to  a  noticeable  degree,  and 
in  some  cases  to  such  an  extent  as  to  permit 
of  dribbling  of  the  saliva,  and  short  of  this  a 
vacant  expression  may  be  present.  This  in- 
stantly disappears  when  the  patient  is  spoken  to. 
This  may  exist  quite  independently  of  alcoholism, 
but  when  accompanied  by  other  signs  of  drinking 
is  conclusive.  The  tremor  of  the  hands  is  an 
easily  noted  sign,  and  the  effort  the  patient 
makes  to  hide  it  only  serves  to  emphasise  it. 
There  are  many  causes  for  this  trembling  of  the 
hands,  and  one  must  be  careful  not  to  judge  a 
patient  by  this  alone,  or  one  may  fall  into  very 


TREATMENT  203 

grievous  error.  It  is  only  when  we  exclude  all 
other  causes,  and  find  this  trembling  associated 
with  other  signs,  that  we  are  justified  in  ac- 
cepting it  us  such.  The  weak  knees  are  par- 
ticularly noticeable  if  the  patient  is  sitting 
on  a  low  chair.  He  will  then  give  support 
to  them  by  spreading  his  feet  and  bringing  his 
knees  together,  forming  a  triangle  with  the  apex 
at  the  knees.  But  it  is  so  long  before  these  signs 
are  apparent  that  we  must  make  our  diagnosis 
if  w^e  wish  to  do  the  best  for  our  patient,  and  we 
must  therefore  try  to  detect  the  presence  of  the 
craving  without  these.  We  therefore  turn  to 
those  means  of  detecting  the  presence  of  the 
craving  at  a  much  earlier  stage.  Let  us  take  a 
case.  A  wife  being  anxious  about  her  husband's 
drinking  habits  induces  him  to  visit  the  doctor. 
He  laughingly  tells  the  doctor  that  he  has  only 
come  to  please  his  wife,  and  that  there  is  no- 
thing the  matter  with  him.  He  looks  perfectly 
healthy.  Now,  how  are  we  to  proceed  in  order 
to  decide  which  of  the  two  is  correct  ?  The 
history  reveals  occasional  outbreaks  of  drinking, 
but  nothing  beyond  what  many  men  do  who 
are  not  alcoholic,  therefore  we  get  no  help  in 
that  direction.  We  next  systematically  examine 
the  nervous  system  from  head  to  feet  and  find 
it  apparently  sound.     Then  we   fall  back  upon 


204  MODERN  TREATMENT  OF  ALCOHOLISM 

the  history  and  sift  it  thoroughly,  in  order  to 
see  if  there  is  any  shred  of  evidence  in  favour 
of  a  craving  ;  we  find  nothing.  Next  we  proceed 
to  question  the  patient  closely  with  regard  to 
any  pains  or  unusual  sensations,  and  especially 
any  which  are  relieved  by  alcohol.  If  we  can 
find  one  we  should  place  a  finger  upon  it  and 
not  let  go  until  we  are  satisfied  that  it  has 
nothing  to  do  with  the  craving.  On  the  other 
hand,  if  we  find  such  a  pain  or  abnormal  sensation 
which  is  relieved  by  alcohol  and  returns  whenever 
the  alcohol  is  withdrawn,  we  are  possibly  dealing 
with  the  craving.  The  forms  which  these  pains 
and  sensations  take  are  numerous,  as  we  may 
well  expect  when  it  is  remembered  that  these 
are  due  to  diseased  nerves.  We  must  be  pre- 
pared for  all  forms  of  indefinite  pains  throughout 
the  body,  those  of  the  heart  and  stomach  being 
in  the  forefront  for  number.  It  is  a  question 
whether  gastric  discomfort  or  palpitation  has 
first  place,  but  I  think  it  is  a  question  of  sex, 
men  favouring  the  stomach  while  women  favour 
the  heart.  An  indefinite  boring  or  burning 
sensation,  sometimes  amounting  to  actual  pain, 
is  a  very  common  form.  This  is  generally  in 
the  abdominal  region.  But  the  question  may  be 
asked  here,  how  are  we  going  to  distinguish 
these  symptoms  from  those  due  to  other  forms 


TREATMENT  205 

of  nerve  diseases  ?  It  must  be  remembered 
that  we  first  of  all  examined  the  nervous  system 
and  found  nothing ;  then  we  had  a  history 
of  excessive  drinking,  and  these  pains  or  sensations 
are  always  relieved  by  alcohol  and  return  when 
the  alcohol  is  withdrawn.  This  would  not  hold 
good  in  all  cases  of  nerve  trouble.  Let  us  now 
suppose  that  our  examination  has  not  revealed 
anything  definite  ;  how  are  we  to  proceed  with 
the  diagnosis  ?  There  is  only  one  thing  to  be 
done.  The  patient  has  laughed  at  the  idea 
of  his  being  an  alcoholic,  and  has  said  that  he 
can  take  it  or  leave  it  alone — that  it  makes  no 
difference  to  him.  This  gives  us  the  desired 
opening,  and  we  request  him  to  be  an  abstainer 
for  a  month  or  two.  It  is  now  the  duty  of  the 
wife  to  note  any  changes  in  him  during  that 
time.  If  he  is  an  alcoholic  the  withdrawal  of  the 
alcohol  will  accentuate  the  nerve  irritation  which 
was  so  slight  that  we  could  not  detect  it  while  he 
was  drinking,  and  it  will  manifest  itself  in  some 
form  or  other.  If  the  man  is  candid  he  will  admit 
missing  the  alcohol,  but  failing  this  we  must 
depend  upon  the  wife  for  any  evidence  of  such 
a  change. 

Enough  has  been  said  to  show  how  the  diagnosis 
is  made.  We  now  proceed  to  classify  him. 
If  we  find  no  craving  we  are  justified  in  diagnosing 


2o6  MODERN  TREATMENT  OF  ALCOHOLISM 

the  case  as  non-alcoholic.  If,  on  the  other  hand, 
we  do  find  a  craving  we  proceed  to  the  classifica- 
tion. The  classification  of  patients  is  com- 
paratively easy.  Having  diagnosed  a  craving, 
we  next  proceed  to  ascertain  if  it  is  continuous  or 
intermittent.  If  the  former,  we  place  him  in 
class  I.  If  the  latter,  we  have  to  decide  whether 
to  place  him  in  class  2  or  3.  If  there  is  no 
mania  we  place  him  in  class  2  ;  if  mania  is 
present,  class  3.  If  no  craving  is  present  we 
place  him  in  class  4.  It  must  be  remembered 
that  these  divisions  are  arbitrary,  and  it  will  be 
found  that  it  is  not  always  easy  to  sharply  limit 
the  classes,  for  cases  will  be  constantly  cropping 
up  which  are  borderland  cases,  and  must  be 
dealt  with  on  their  merits  ;  but  the  great  majority 
of  cases  will  drop  easily  into  one  or  other  of  these 
classes. 

Having  diagnosed  our  cases  and  having 
properly  classified  them,  we  next  proceed  to  the 
all-important  question  of  treatment.  We  have 
been  to  great  pains  in  order  to  classify  the 
patient — we  now  take  advantage  of  our  classifica- 
tion and  will  therefore  consider  the  question 
of  the  treatment  of  each  class  separately.  The 
most  important  class  of  cases  is  class  i.  In 
describing  the  treatment  of  these  patients  we 
not    only  take    the    most    important    class,  but 


TREATMENT  207 

we  will  be   able   to   apply   the   same   treatment 
with  certain  modifications  to  classes  2  and  3. 

The  main  object  of  this  book  is  the  presentation 
of  a  successful  method  of  treatment  and  the 
curing  of  alcoholism.  In  discussing  drug  treat- 
ment it  will  be  necessary  to  come  into  contact 
with  long  held  views  of  an  opposing  nature.  As 
I  wish  to  be  perfectly  fair  to  all,  I  will  describe 
every  well-known  form  of  treatment,  conferring 
upon  each  every  advantage  that  I  consider  it 
merits.  Aside  from  the  question  of  fairness,  I 
do  not  hesitate  to  take  up  the  time  of  the  reader 
in  this  matter,  as  every  one  of  the  methods 
described  has  its  value,  and  in  its  proper  place 
proves  a  useful  help  in  any  proper  method  of 
treatment.  The  following  are  some  of  the  best- 
known  treatments  :  The  home  treatment,  the 
moral  treatment,  treatment  by  travelling,  the 
fruit  treatment,  treatment  in  colonies,  treatment 
by  restraint,  and  the  drug  treatment. 

The  Home  Treatment 

Probably  this  is  the  most  commonly  practised 
of  all  treatments  for  alcoholism.  There  are 
several  reasons  for  this,  the  main  ones  being  the 
question  of  cost,  the  fear  of  publicity,  and  the 
faith  in  home  or  personal  influence — all  three  are 


2o8  MODERN  TREATMENT  OF  ALCOHOLISM 

powerful  factors.  I  think  the  least  powerful  is 
the  question  of  cost,  for  women  especially  will 
make  almost  any  sacrifice  in  order  to  get  the 
son  or  husband  cured.  The  personal  influence 
factor  is  very  strong  ;  in  some  women  no  number 
of  failures  will  convince  them  that  they  are  not 
going  to  succeed  in  the  end.  This  is  a  great 
drawback  to  the  patient,  as  they  allow  the  disease 
to  reach  a  stage  when  no  one  can  do  any  good. 
They  completely  fail  to  recognise  the  subtle 
changes  going  on  in  the  patient's  system,  their 
main  object  being  to  cut  short  each  attack.  It 
is  sometimes  almost  impossible  to  restrain 
oneself  when  listening  to  their  transparent 
efforts  to  cover  up  the  real  condition  of  things. 
But  I  think  the  strongest  reason  of  the  three  is 
the  dread  of  publicity.  This  last  factor  alone 
prevents  a  very  large  number  of  patients  from 
being  sent  to  homes  for  treatment.  One  cannot 
altogether  blame  them  for  this  ;  public  opinion 
has  long  been  trained  to  consider  alcoholism  as 
a  vice,  not  a  disease — therefore  to  have  a  drinking 
one  in  the  family  was  a  terrible  disaster.  How 
then  could  one  publish  the  whole  thing  by  sending 
the  patient  to  a  home  ?  Wliatever  the  reason, 
it  is  deplorable  that  patients  are  prevented  from 
obtaining  the  proper  and  effectual  help  which 
they    so    much    need.      The    home    treatment 


TREATMENT 


209 


consists  of  an  attempt  to  prevent  the  patient 
from  obtaining  supplies,  and  in  feeding.  I 
have  said  that  there  is  something  useful  in  all 
forms  of  treatment ;  in  the  home  treatment  it  is 
the  feeding.  There  are  large  numbers  of  remedies 
advertised  in  the  daily  press  for  the  home  treat- 
ment of  alcoholism.  Patients  will  be  well  advised 
to  keep  their  money  in  their  pockets  when  con- 
templating their  purchase. 

The  Moral  Treatment 

For  a  patient  without  a  craving  this  is  the 
proper  course.  Home  influence  ought  to  have 
full  play  in  all  these  cases,  backed  by  all  the 
outside  influence  the  friends  can  command.  The 
excessive  drinking  of  these  patients  is  a  deliberate 
act ;  it  is  vice  pure  and  simple — if  I  may  be 
permitted  to  use  the  word  "  pure  "  in  this  con- 
nection. These  men  cannot  be  cured  with 
medicine  because  there  is  no  physical  disease 
to  treat.  They  can  cease  drinking  whenever 
they  wish  to  do  so.  It  is  the  confounding  of 
these  patients  with  alcoholics  which  has  caused 
so  much  confusion  of  the  whole  question.  They 
have  no  right  to  be  considered  as  alcoholics  at  all. 
One  cannot  expect  the  public  to  discriminate 
between  the  man  who  takes  alcohol  deliberately 
14 


210  MODERN  TREATMENT  OF  ALCOHOLISM 

and  those  who  take  it  because  they  cannot  help 
taking  it.  There  is  no  outward  sign  to  dis- 
tinguish one  from  the  other.  To-day  the  Govern- 
ment fosters  the  same  idea  by  its  punishment 
of  both  classes.  It  is  just  as  great  a  crime  to 
send  an  alcoholic  to  prison  as  a  punishment  for 
his  drinking  as  it  would  be  to  send  a  man  to  prison 
for  eating  when  he  is  hungry,  or  sleeping  when 
he  is  tired.  Punish  those  of  class  4  as  much  as 
you  like,  provided  you  can  thereby  induce  them 
to  reform,  but  to  apply  the  same  rule  to  the 
alcohohc  is  to  admit  complete  ignorance  of  the 
whole  subject. 

Treatment  by  Travelling 

This  is  a  favourite  method  with  manj^  doctors. 
The  usual  thing  is  to  send  a  patient  on  a  long 
voyage  in  a  sailing  vessel,  either  for  one  or  two 
years,  in  the  hope  that  the  healthy  life  and  the 
long  periods  between  ports  will  enable  him  to  re- 
gain control  of  himself.  Wiatever  good  there 
may  be  in  it  is  completely  lost  if  the  patient  is 
sent  on  a  steamer.  The  hfe  on  the  latter  is  more 
likely  to  turn  a  moderate  drinker  into  an  alcoholic 
than  to  cure  him.  Like  all  other  treatments,  it 
has  some  merit  in  it.  Let  us  examine  its  merits 
and  demerits  for  a  moment.     Let  us  take  the 


TREATMENT  211 

case  of  a  patient  sent  on  a  sailing  ship  first.  What 
class  are  we  to  send  ?  Class  4  is  ruled  out  at 
once  ;  theirs  is  a  question  of  morals,  and  one  does 
not  send  any  one  to  sea  to  improve  their  morals. 
Class  3  is  also  ruled  out,  as  one  does  not  send 
maniacs  to  sea.  There  remain  classes  i  and  2. 
In  class  2  the  periods  may  synchronise  with  the 
arrival  at  ports  ;  if  this  should  happen  in  even 
a  small  number  of  landings,  it  will  completely 
annul  all  the  advantages  otherwise  gained. 
Alcoholics  of  this  class  do  not  drink  during  the 
intervals  between  the  attacks  ;  indeed,  many  of 
them  absolutely  refuse  to  do  so.  Therefore  they 
might  as  well  be  at  home,  for  any  advantage  to 
health  gained  through  the  interval  is  lost  during 
the  attacks.  Another  factor  in  the  case  must  not 
be  lost  sight  of,  and  that  is  the  pecuhar  effect  of 
the  sea  on  most  men  when  on  sailing  ships,  namely, 
a  very  strong  desire  to  take  alcohol  to  excess  as 
soon  as  they  land.  The  sudden  change  from 
the  monotonous  life  to  that  of  the  activity  of  the 
port  may  be  the  cause,  or  it  may  be  due  to 
some  pecuhar  effect  of  the  sea  air.  It  does  not 
matter  which,  the  fact  remains  that  it  is  a  well- 
known  result  of  such  a  life,  and  consequently  it 
is  a  factor  which  must  be  reckoned  with.  If  this 
be  true  of  class  2,  how  much  more  will  it  apply  to 
class  I,  for  here  we  have  a  man  who  has  a  craving 


212  MODERN  TREATMENT  OF  ALCOHOLISM 

which  never  leaves  him   and  which  temptation 
makes  irresistible.     Is  it  likely  that  he  will  escape 
when  the  results  are  so  disastrous  to  non-alco- 
holics ?     Surely   this   is   expecting   miracles.     If 
we  now  consider  the  case  of  those  travelling  by 
steamers,  we  have  to  reckon  with  two  additional 
factors,  namely,  the  more  frequent  ports  of  call  and 
the  notorious  smoking-room  life.     I  have  crossed 
the   Atlantic   thirty   times,   and   I   have   always 
felt   sorr}^  for   alcoholics   whom   I   have   met   at 
sea.     At  the  same  time  I  could  not  help  feeling 
much  more  sorry  for  the  friends  at  home  who 
were  expecting  to  see  the  patient  return  benefited 
by  the  trip.     The  life  aboard  steamers  lends  itself 
in  some  peculiar  way  to  drinking.     There  seems 
to  be  some  inducement  for  men  to  let  themselves 
go    when    on    board.     Many    of   the    clergy    are 
peculiarly  liable  to  this  effect  of  sea  life  ;    I  have 
seen  members  of  the  cloth  carried  to  bed  night 
after  night,  helpless,  whom  their  wives  declared 
w^ere  always  sober  men  at  home.     I  have  met 
some  of  these  very  men  a  week  or  two  after  their 
landing,  and  found  that  they  had  quite  dropped 
their  excesses.     I  well  remember  a  man  who  had 
been  so  bad  that  the  captain  was  compelled  to 
give  orders  that  he  was  not  to  be  served  with  any 
more  drink.     For  several  days  he  was  as  drunk  as 
usual,  and  no  one  could  tell  where  he  obtained 


TREATMENT  213 

his  alcohol.  Finally,  it  was  discovered  that  he 
used  to  fish  it  up  from  the  store-room  through  a 
ventilator  at  night.  If  the  captain  should  stop 
the  grog  of  a  passenger,  he  often  obtains  his  drink 
through  the  kind  offices  of  a  fellow-passenger. 
With  proper  treatment  and  supervision  the  sea 
trip  may  be  a  very  useful  help  ;  without  these  it 
is  in  my  opinion  worse  than  useless. 

The  Fruit  Treatment 

There  is  not  much  of  interest  to  be  said  with 
regard  to  the  fruit  cure.  Like  all  other  methods 
of  treatment  it  has  its  virtues  ;  by  regulating  the 
system  and  cooling  the  blood,  it  lessens  the 
accumulation  of  toxins  and  consequent  nerve 
irritation  and  depression.  This  may  be  success- 
ful in  very  slight  cases  in  preventing  drinking, 
and  in  some  advanced  cases  in  lessening  it.  As 
a  cure  in  itself  it  is  impossible  ;  as  a  help  to  other 
treatment  it  is  valuable  and  should  be  used 
whenever  possible.  Before  leaving  the  question 
of  the  fruit  treatment,  I  would  like  to  refer  once 
more  to  the  marvellous  power  of  lemons  to 
rapidly  destroy  the  toxins  in  the  system.  I  have 
seen  the  hard,  dry,  brown  typhoid  tongue  and 
the  heavy  mental  depression  with  their  muscular 
weakness  and  loathing  of  all  food  melt  away  like 


214  MODERN  TREATMENT  OF  ALCOHOLISM 

magic  in  a  few  hours  under  the  use  of  strong, 
freshly -made  lemonade.  It  is  obvious  that  such 
a  powerful  aid  should  not  be  neglected  in  any 
well-considered  scheme  of  treatment.  Fresh 
lemon  juice  was  very  popular  once  as  a  treatment 
in  case  of  acute  rheumatism,  and  has  well-known 
anti-scorbutic  properties.  These  effects  are  not 
found  in  the  citric  acid  alone.  The  fruit  must  be 
fresh  and  the  drink  freshly  prepared  to  be  of 
service. 

Treatment  by  Colonies 

A  great  deal  of  money  has  been  spent  and 
labour  given  in  a  well-meant  effort  to  reclaim  the 
alcoholic  by  means  of  farm  colonies.  One  cannot 
help  admiring  the  devotion  and  enthusiasm  of 
many  engaged  in  this  work,  but,  knowing  the 
results  obtained,  one  entirely  deplores  this  misuse 
of  both  time  and  money,  which,  if  used  in  the  right 
way,  would  have  been  of  such  lasting  benefit  to  so 
many  alcoholics.  Value  for  money  spent  is  not 
obtained  and  never  can  be  under  the  present 
system.  The  whole  movement  is  based  on  a 
wrong  principle,  and  consequently  must  fail  in 
its  object  until  such  time  as  this  may  be  brought 
into  harmony  with  our  present  knowledge  of 
alcoholism.  Like  the  foregoing  treatment  of 
alcoholism,  this  also  has  its  virtues,  and  because 


TREATMENT  215 

of  these  it  is  supported  by  its  patrons.  Its  sup- 
porters believe  that  alcohoHsm  may  be  cured  by 
placing  the  alcoholic  on  a  farm,  the  work,  food, 
and  moral  training  being  regulated  to  suit  the 
case.  The  result  of  such  treatment  is  the  im- 
provement both  of  general  health  and  the  moral 
tone,  to  implant  hope  in  the  hopeless,  and  to 
induce  others  to  change  their  vagaband  life  for  a 
useful  one.  These  are  all  very  desirable  objects, 
but  touch  only  one  phase  of  alcoholism  ;  that  is 
the  voluntary  or  vicious  drinker.  By  improving 
his  health  and  morals  and  inducing  a  more 
regular  life,  he  may  be  led  to  give  up  alcohol ; 
but  this  man  is  not  a  true  alcoholic,  and  I  do  not 
believe  that  a  genuine  alcoholic  can  be  cured 
by  such  means  ;  the  mere  improvement  of  the 
general  health  and  morals  alone  will  not  remove 
the  craving  for  alcohol,  and  so  long  as  the  craving 
remains  there  can  be  no  cure.  Where  a  genuine 
craving  has  existed  in  patients  on  farm  colonies 
and  the  patients  have  been  benefited  by  their 
stay  there,  it  is  only  a  case  of  reduced  craving 
and  not  a  cure.  Any  restraint  put  upon  the 
patient  will  break  him  down,  allowing  full  play 
to  the  disease  within  him.  Almost  all  of  these 
patients  relapse  under  a  strain.  Although  this 
method  of  treatment  will  not  cure  real  alcoholics, 
there    are    many    suitable    for    such    treatment. 


2i6  MODERN  TREATMENT  OF  ALCOHOLISM 

Many  drink  to  excess  from  a  desire  to  drown  their 
misery  or  despair.  Place  these  on  a  farm  colony 
and  you  may  do  good.  There  are  a  thousand  in 
our  jails  who  ought  to  be  on  these  farm  colonies 
instead.  It  is  my  firm  conviction  that  no  one 
ought  ever  to  be  sent  to  prison  for  excessive 
drinking  alone.  Nothing  but  harm  can  come  of 
it.  Let  us  look  at  the  question  more  closely  for  a 
moment,  and  we  will  easily  see  why  these  farm 
colonies  cannot  cure  alcoholics.  The  genuine 
alcoholic  drinks  because  of  a  craving.  If  he 
belongs  to  class  i  this  craving  will  be  a  constant 
factor,  and  unless  he  is  placed  under  restraint  he 
will  obtain  the  alcohol  he  requires  to  satisfy  this 
craving.  He  must  therefore  needs  be  a  failure 
on  a  farm  colony.  If  he  belongs  to  class  2  he 
will  be  subject  to  periodical  attacks,  and,  no 
matter  how  well  he  may  be  before  the  attack, 
he  will  resort  to  the  drink  on  each  return  of  the 
craving. 

Treatment  by  Restraint 

Any  criticism  of  this  method  involves  large 
issues — there  are  so  many  toes  to  be  trodden 
upon  that  one  cannot  stir  without  being  on  some 
one's.  First  we  have  the  Government  with  its 
jails  full  of  alcoholics,  of  the  majority  of  whom  it 
may  be  said  that  their  only  crime  is  that  they 


TREATMENT  217 

are  the  victims  of  a  physical  disease.  Then  we 
have  the  old-fashioned  homes  where  restraint  is 
still  believed  in,  Municipal  Homes,  homes  in 
dreary  remote  parts  of  the  country,  etc.  etc.  One 
does  not  feel  free  to  speak  one's  mind  on  this 
subject,  but  a  simple  statement  of  facts  ought 
not  to  be  objectionable  to  any  one.  Two  things 
are  aimed  at  in  treatment  by  restraint,  namely, 
the  separation  of  the  patient  from  alcohol  and 
the  improvement  in  his  general  health.  The 
hope  is  that  the  improved  health  will  spell  in- 
creased will-power  ;  it  is  a  sort  of  training  of  the 
will-power.  To  my  mind  there  are  two  great 
errors  in  this  system.  The  first  is  the  attempt 
to  separate  the  patient  from  alcohol  by  force — a 
thing  which  can  never  be  successful  while  the 
disease  is  present  ;  the  second  is  in  attempting 
to  train  the  patient  to  withstand  temptation 
by  shutting  him  away  from  temptation.  With 
regard  to  alcoholics  all  experience  teaches  us 
that  no  amount  of  precaution  will  prevent  a 
patient  from  obtaining  alcohol  short  of  absolute 
restraint,  if  he  is  afflicted  with  the  craving.  We 
also  learn  from  experience  that  no  amount  of 
restraint  will  remove  that  craving.  Therefore  we 
must  conclude  that,  touching  the  question  of 
craving,  restraint  leaves  the  patient  at  the  end  of 
his  imprisonment  just  where  it  found  him.     I  am 


2i8  MODERN  TREATMENT  OF  ALCOHOLISM 

quite  prepared  to  admit  that  the  patient  may 
leave  the  home  in  a  better  physical  condition 
than  when  he  entered  it,  but  the  question  at 
once  arises,  Is  it  necessary  to  lock  up  a  patient 
for  from  two  to  seven  years  in  order  to  merely 
improve  his  health  ?  Again,  we  must  not  forget 
that  patients  with  the  most  robust  health  drink 
as  freely  as  others,  so  that  the  mere  improvement 
in  health  will  not  in  itself  prevent  drinkmg  in 
those  afflicted  with  the  craving.  If  we  admit 
this,  and  the  evidence  of  it  is  abundantly  about 
us,  all  reasons  for  placing  patients  of  classes  i 
and  2  under  restraint  disappear.  With  regard 
to  the  voluntary  drinker,  I  cannot  see  what  is 
hoped  for  from  placing  him  under  restraint.  It 
is  admitted  that  he  can  take  it  or  leave  it  alone  as 
he  pleases,  that  the  question  of  craving  does  not 
enter  into  his  case,  and  in  most  cases  he  is  in  good 
health.  What  then  can  restraint  do  for  him  ? 
With  regard  to  these  three  classes,  I  have  shown 
that  nothing  good  is  to  be  hoped  for  from  restraint, 
but  much  remains  to  be  said  with  regard  to  the 
harm  which  may  follow  such  imprisonment.  In 
all  homes  there  are  always  a  number  of  chronic 
"  wasters  "  who  are  placed  there  just  as  others  are 
sent  to  the  Colonies,  to  be  out  of  the  way  ;  and 
daily  association  with  these  men  must  have  a 
demoralising  effect.     Shut  up  against  their  will, 


TREATMENT  219 

they  are  just  in  the  mood  to  be  influenced  by  the 
distorted  views  of  the  wasters.  Some  of  these 
views  are  absorbed  for  life.  They  also  learn  to 
loaf  and  gamble,  and  some  from  that  time  become 
chronic  loafers. 

With  regard  to  the  dipsomaniac,  these  homes 
offer  the  very  best  means  of  placing  him  under 
proper  restraint.  These  patients  should  not  be 
treated  without  some  resort  to  restraint,  and  the 
homes  offer  the  very  best  opportunities  for  this 
treatment.-  While  these  homes  are  the  best  place 
for  such  patients,  restraint  alone  will  not  cure 
them,  but  of  this  we  will  speak  later  on  when  we 
describe  the  question  of  drug  treatment.  To 
sum  up,  we  find  that  restraint  is  useless  in 
classes  i,  2,  and  4,  but  necessary  in  all  cases  of 
dipsomania.  We  further  find  that  it  is  very 
likely  to  prove  harmful  in  many  cases  of  the 
former  classes.  All  this  is  true  of  the  ideal  home, 
but  what  about  the  great  majority  of  homes 
which  are  anything  but  ideal  ?  There  are 
homes  in  this  fair  country  of  ours  receiving 
alcoholic  patients  for  treatment  which  are  not 
only  devoid  of  moral  influences  but  which  have  a 
strong  opposite  influence.  Not  only  is  the  alcohol 
not  kept  from  the  patients,  but  it  is  given  to 
them  in  order  to  get  the  patient  to  remain  longer 
in   the    home.     These    are    the  worst   homes,  of 


220  MODERN  TREATMENT  OF  ALCOHOLISM 

course,  but  even  in  some  of  the  better-class  homes 
the  patients  are  often  able  to  obtain  drink  at 
times,  simply  because  it  is  impossible  with  the 
limited  staff  kept  to  prevent  it.  The  many  ways 
in  which  supplies  may  be  obtained  would  fill  a 
book,  but  I  will  mention  a  few  in  order  to  show 
how  impossible  it  is  to  prevent  it  in  most  of  our 
homes. 

Some  homes  offer  boating  and  fishing  facilities, 
and  the  patients  arrange  to  have  the  bottles 
attached  to  a  float,  and  when  boating  are  able  to 
secure  them  under  the  very  eyes  of  the  officer  in 
charge.  Another  favourite  method  is  to  fish  it  up 
over  the  wall  when  brought  by  the  only  too  willing 
go-between.  With  the  limited  staff  so  often  kept, 
it  is  impossible  to  watch  all  parts  of  the  grounds 
at  once,  and  men  who  are  bent  upon  getting 
alcohol  and  who  have  nothmg  else  to  do  will  out- 
wit the  very  best  watching.  There  is  only  one 
possible  plan,  and  that  is  to  make  the  patient 
absolutely  indifferent  to  the  alcohol.  By  my 
method  of  treatment  the  patient  requires  no 
watching  ;  on  the  other  hand,  I  often  place  a  small 
bottle  of  whisky  in  the  patient's  bedroom  and 
tell  him  to  take  it  if  he  feels  he  wants  it.  It  is  as 
useless  to  attempt  to  watch  an  alcohohc  patient 
as  to  look  for  a  needle  in  a  haystack,  and  it  is 
always  a  pitiful  sight  to  me  to  see  the  hopeless 


TREATMENT  221 

attempts  made  by  friends  or  relatives  to  prevent 
the  patient  from  obtaining  it.  It  is  always  a  losing 
game  for  the  watcher,  and  in  the  end  nothing 
is  gained,  for  if  the  patient  is  an  alcoholic  with  a 
craving  he  will  gratify  that  craving  as  soon  as 
he  gets  the  opportunity.  The  only  sensible  thing 
to  do  is  to  destroy  the  craving,  and  the  necessity 
for  watching  will  disappear.  To  sum  up,  then,  we 
find  that  while  restraint  is  very  little  good  in 
classes  1,2,  and  4  it  may  prove  to  do  great  harm. 
There  has  always  been  a  treatment  of  alcohol- 
ism by  means  of  drugs,  even  from  very  early 
times,  but  none  of  these  removed  the  craving  ; 
they  merely  helped  the  patient  to  recover  from 
an  attack,  and  at  best  were  only  palliatives. 
None  of  them  struck  at  the  root  of  the  trouble. 
The  drug  treatment  which  I  have  used  for  twenty 
years  goes  to  the  very  core  ;  it  removes  the 
craving.  Unless  one  can  remove  the  craving 
one  is  only  playing  with  treatment  —  any 
treatment  which  does  not  aim  at  the  destruc- 
tion of  the  craving  not  only  fails  to  cure  the 
patient,  but  is  likely  to  so  discourage  him  as  to 
prevent  him  from  trying  other  treatment.  Apart 
from  this,  it  is  also  useless  waste  of  time  and 
money.  All  former  drug  treatments  were  of 
this  nature,  and  were  therefore  largely  responsible 
for  the  universal  belief  that  once  a  man  became 


222  MODERN  TREATMENT  OF  ALCOHOLISM 

a  confirmed  alcoholic,  nothing  short  of  a  miracle 
could  save  him  from  the  alcoholic  grave.  It  is 
therefore  of  the  utmost  importance  that  the 
first  treatment  of  the  patient  should  be  a  sound 
and  scientific  one,  offering  a  reasonable  expecta- 
tion of  an  entire  cure.  The  treatment  which  I 
am  about  to  describe  is  such  an  one.  The 
modern  drug  treatment  is  curative  in  a  very 
large  proportion  of  all  suitable  cases.  The  old 
treatment  has  largely  depended  upon  circum- 
stances quite  apart  from  the  action  of  the  drugs 
administered  for  a  small  number  of  its  successes, 
while  there  is  no  doubt  about  the  result  of  the 
modern  in  all  suitable  cases.  This  is  a  strong 
statement  to  make,  but  it  is  made  on  the  experi- 
ence of  twenty  years,  and  I  expect  to  justify 
this  statement  when  I  come  to  the  question  of 
the  actual  results  obtained. 


Its  Range  of  Application 

The  next  question  of  interest  is  what  cases 
are  suitable  for  treatment  by  drugs.  It  is  most 
important  to  know  when  to  administer  the  treat- 
ment and  when  to  refuse  to  do  so  ;  to  apply  it 
indiscriminately  to  all  cases  offered  for  treat- 
ment is  not  only  to  court  failure  but  to  discredit 
the  treatment.     When  I  first  used  the  treatment. 


TREATMENT  223 

I  hoped  for  success  in  every  case,  but  I  soon 
learned  that  everything  depended  upon  the  class 
of  patient  treated.  I  therefore  devised  the 
rough  classification  adopted  in  this  book.  If  we 
examine  this  classification,  we  will  find  that  in 
the  first,  second,  and  third  classes  the  patient 
has  a  craving,  while  in  the  fourth  class  he  has  not. 
The  treatment  should  be  applied  in  all  cases  where 
the  patient  has  a  craving  for  alcohol,  therefore 
one  may  hope  for  success  in  classes  i,  2,  and  3  ; 
it  is  useless  to  expect  success  in  class  4,  for  there 
is  no  scope  here  for  drug  treatment.  Not  only 
is  this  the  case,  but  the  presence  of  such  a  hopeless 
patient  is  demoralising  to  the  other  patients  in 
the  home.  In  order  to  understand  why  a  treat- 
ment for  which  such  definite  results  are  claimed 
can  be  modified  by  an  unfavourable  influence, 
we  must  examine  more  closely  the  question  of 
classification.  In  a  disease  of  this  nature,  no 
classification  can  be  perfect,  and  a  short  experi- 
ence will  teach  us  that  there  is  a  certain  proportion 
of  cases  which  are  a  combination  of  classes  i, 
2,  or  3  with  class  4,  i.e.,  they  are  not  purely 
physical,  but  are  partially  alcoholics  and  partially 
voluntary  drinkers.  Presuming  that  all  volun- 
tary cases  are  refused  treatment,  it  is  from  the 
mixed  cases  that  any  failures  will  occur.  It 
will  be   apparent   to   all   that   this   combination 


224  MODERN  TREATMENT  OF  ALCOHOLISM 

of  vice  and  disease  will  vary  with  different  cases, 
and  just  as  vice  or  disease  predominates  so 
will  failure  or  success  follow.  It  is  manifest  that 
in  all  homes  there  will  be  a  certain  number  of 
patients  of  this  mixed  class,  for  it  is  impossible 
for  any  doctor  to  tell  at  first  the  exact  character 
of  such  cases.  They  require  something  more 
than  drug  treatment,  and  are  therefore  subject 
to  disturbing  influences  ;  this  question  will  be 
elaborated  later  on.  The  treatment  is  unsuitable 
for  all  of  class  4  and  all  those  of  the  mixed 
cases  m  which  vice  largely  predominates  over 
disease.  It  is  always  difficult  to  make  a  correct 
selection  of  suitable  cases  from  among  those  of  a 
mixed  nature.  The  plan  I  have  usually  adopted 
is  to  question  the  patient  carefully  as  to  his 
desire  to  be  cured.  If  this  is  satisfactory,  and 
is  corroborated  by  his  friends,  I  do  not  refuse 
treatment,  but  even  then  one  is  liable  to  be 
misled,  for  some  patients  wish  for  treatment  not 
with  any  desire  to  be  cured,  but  from  other 
personal  motives.  Such  patients  may  or  may 
not  prove  curable.  The  different  motives  which 
influence  patients  to  seek  treatment  may  be 
judged  from  the  following  cases.  An  army 
captain  led  me  to  believe  that  he  desired  to  be 
cured  ;  when  leaving  he  told  me  that  he  had  no 
intention  of  remaining  a  teetotaller,  as  he  merely 


TREATMENT  225 

took  treatment  in  order  to  enable  him  to  pass 
the  examination  which  he  had  to  undergo  before 
he  would  be  allowed  to  return  to  his  command 
in  India.  Another  patient  desired  treatment  in 
order  to  be  accepted  in  marriage — another  in 
order  to  retain  his  situation.  Some  wish  treat- 
ment in  order  to  avoid  disinheritance,  and  others 
merely  to  please  an  anxious  parent  or  wife.  There 
are  many  other  reasons  why  patients  wish  to 
deceive  the  doctor  ;  even  with  great  experience 
and  the  most  careful  examination,  a  certain 
number  of  patients  must  be  taken  on  trust. 
The  doctor  should  always  reserve  the  right  to 
dismiss  such  cases  from  further  treatment  if  he 
finds  on  closer  acquaintance  they  are  not  suit- 
able ones. 

Having  accepted  the  patient  for  treatment,  the 
next  thing  is  to  prepare  him  for  the  regular 
course  ;  this  is  accomplished  by  means  of  drugs 
and  advice — both  are  essential  to  success.  If 
we  are  wise  we  shall  not  neglect  either,  especially 
the  advice. 

The  Drug  Preparation 

Unless  there  are  reasons  for  acting  otherwise, 

it  is  advisable  to  administer  a  mercurial  followed 

by  an  alkaline  purgative  ;   4  grains  of  calomel  at 

bedtime  and  a  Seidlitz  powder  the  next  morning 

15 


226  MODERN  TREATMENT  OF  ALCOHOLISM 

is  useful.  If  the  patients  should  object  to  using 
the  Seidhtz  powder  (as  they  sometimes  do), 
this  may  be  replaced  by  |  oz.  of  sodium  sulphate. 
The  failure  to  get  satisfactory  results  from 
Seidlitz  powders  is  often  due  to  an  improper 
preparation,  for  many  persons  do  not  know  how 
to  use  such  a  simple  thing  as  a  Seidlitz  powder. 
The  Seidlitz  powder  should  be  a  double  one,  it 
should  be  taken  at  least  half  an  hour  before 
breakfast,  and  the  patient  should  move  about 
afterwards  and  not  he  in  bed.  The  method  of 
mixing  it  is  also  important  :  in  two-thirds  of  a 
tumblerful  of  warm  water  (blood  heat)  dissolve 
the  blue  powder  thorough^,  then  add  gently  the 
white  powder,  so  as  not  to  cause  the  mixture  to 
overflow  the  glass.  Allow  the  effervescence  to 
subside  completely  before  taking.  The  general 
belief  that  it  is  necessary  to  drink  while  foaming 
leads  to  haste  and  waste.  Many  patients  who 
fail  to  obtain  satisfactory  results  from  Seidlitz 
powders  will  find  the  above  method  of  using  a 
successful  one.  We  can  accomphsh  much  good 
by  such  a  simple  preparatory  treatment.  The 
blood  pressure  is  lowered,  and  the  risk  of  cerebral 
congestion  greatly  lessened  ;  the  whole  intestinal 
tract  is  swept  clear  of  the  products  of  indigestion 
which  generally  accompanies  the  previous 
drinking,  not  the  least  important  of  these  being 


TREATMENT  227 

the  large  amount  of  toxins  generally  present 
Any  excess  of  bile  present  is  also  eliminated. 
If  the  patient  is  liverish,  it  is  further  advisable 
to  give  5-10  grains  of  salicylate  of  sodium  an 
hour  before  the  calomel ;  the  result  of  this  treat- 
ment is  often  very  striking.  Nerve  irritation 
is  markedly  lessened  ;  the  pulse  lowered,  cerebral 
congestion  greatly  modified,  and  a  general  feel- 
ing of  greater  comfort  induced.  The  patient 
is  more  likely  to  sleep  well,  while  the  system  is 
prepared  for  what  is  to  follow.  But  the  greatest 
gain  of  all  is  the  avoidance  of  delirium  tremens. 
While  it  is  not  always  possible  to  prevent  the 
latter,  this  will  do  so  in  the  majority  of  cases. 
I  am  quite  convinced  that  neglect  of  such  a 
simple  precaution  has  not  only  prevented  cures 
from  being  obtained,  but  has  in  some  instances 
lost  lives.  If  I  seem  to  dwell  unduly  upon  this 
point,  it  is  because  experience  has  taught  me 
that  there  is  no  more  important  point  m  the 
whole  treatment  than  this.  One-half  the  battle 
may  be  gained  in  the  first  night's  treatment.  To 
my  mind  it  is  far  more  important  than  giving 
the  patient  a  sleeping-draught,  for  it  strikes 
at  the  very  root  of  the  insomnia.  Sedatives 
are  merely  palhative,  and  do  nothing  towards 
removing  the  cause. 


228     MODERN  TREATMENT  OF  ALCOHOLISM 

The  Advice 

If  the  preparatory  purgation  is  important,  the 
preparator}^  advice  is  still  more  so.  But  to  give 
advice  is  one  thing,  and  to  get  it  followed  is 
another.  The  doctor  must  first  gain  the  con- 
fidence of  the  patient.  Here  so  much  depends 
upon  the  doctor  himself.  Some  patients  arrive 
at  the  sanatorium  already  convinced  that  the 
treatment  is  a  good  one,  and  quite  prepared  to 
follow  any  advice  given  by  the  doctor  in  charge  ; 
but  these  are  few  in  number.  On  the  other  hand, 
there  are  many  who  arrive  in  quite  the  opposite 
frame  of  mind.  The  success  or  failure  of  their 
treatment  may  be  decided  in  the  very  first  inter- 
view with  the  doctor  in  charge.  It  is  essential 
that  he  should  believe  in  the  treatment  himself  ; 
it  is  just  as  necessary  that  he  should  be  able  to 
convince  his  patient  of  this  belief.  A  sym- 
pathetic and  tactful  man  with  a  fair  knowledge 
of  human  nature  will  have  little  trouble  if  he  will 
only  give  the  necessary  time.  With  some  he  will 
succeed  in  half  an  hour  ;  with  others  it  may  require 
an  hour,  or  often  two  ;  but  whatever  time  is  neces- 
sary it  must  be  given.  I  have  often  given  two 
hours  of  my  time  to  a  new  patient  before  I  could 
convince  him  that  he  had  done  the  right  thing 
in  coming,  and  would  make  a  satisfactory  cure. 


TREATMENT  229 

It  is  also  necessary  to  remove  any  fears  he  may 
have  with  regard  to  the  method  of  treatment. 
Tell  the  patient  at  once  that  there  are  no  prison 
cells  or  padded  rooms,  that  he  will  not  be  tortured 
in  any  way,  and  that  he  will  not  be  suddenly 
deprived  of  alcohol.  Inform  him  that  he  will  not 
be  required  to  sign  any  papers  restricting  his 
personal  liberty.  Having  gained  his  confidence 
and  removed  his  fears,  he  is  in  a  condition  of  mind 
to  listen  to  the  advice  which  is  necessary  to  his 
welfare.  Instruct  him  in  the  rules  and  regula- 
tions, giving  him  a  printed  card  of  the  same,  if 
available.  These  cards  should  have  the  hours 
of  meals  and  treatment  on  them.  This  is  also 
important  in  order  to  prevent  irregularity  of 
attendance  at  treatment,  for  it  is  to  be  remem- 
bered that  you  are  going  to  allow  your  patient 
great  liberty.  Next,  advise  him  as  to  the  im- 
portance of  faithfully  following  the  rules  and 
regulations  in  his  own  interests.  Some  of 
your  advice  may  seem  trivial  to  a  man  of  the 
world  ;  have  the  patience  to  show  him  that 
your  experience  has  taught  you  that  it  is  not 
a  trifling  matter,  but  one  essential  to  the  success 
of  the  treatment.  For  instance,  one  of  the  rules 
will  state  that  it  is  not  permitted  to  smoke 
cigarettes  during  treatment.  This  to  many 
may  seem  quite  an  unnecessary  restriction  ;   take 


230  MODERN  TREATMENT  OF  ALCOHOLISM 

the  trouble  to  explain  your  experience  with 
regard  to  this,  and  do  this  with  any  question  he 
may  raise.  The  result  will  w^ell  repay  you  for 
any  trouble  you  may  take.  If  the  patient 
should  arrive  in  such  a  condition  that  he  is 
unable  to  be  advised,  one  ought  to  take  the  first 
opportunity  of  doing  so.  Pages  of  advice  might 
be  written  with  regard  to  these  matters,  but  one 
cannot  possibly  stop  to  enumerate  them  here, 
but  how  important  they  may  be  the  following 
will  illustrate.  On  one  of  the  bedroom  doors  at 
the  Norwood  Sanatorium  there  was  a  bolt  on  the 
outside,  which  was  there  when  I  took  the  house, 
and  I  did  not  have  it  removed  for  some  time. 
Numbers  of  patients  had  used  that  room,  and 
nothing  of  a  special  nature  had  occurred,  until 
one  night  a  certain  patient  w^as  put  into  the 
room.  He  had  arrived  late,  and  I  had  not  had 
time  to  have  my  usual  talk  with  him.  During 
the  night  he  disappeared,  and  when  found  later 
on  in  London  he  told  me  that  the  sight  of  the 
bolt  on  his  room  door  had  so  alarmed  him  that 
he  got  into  such  a  nervous  state  that  he  felt  he 
would  go  mad  unless  he  could  get  out.  Although 
an  extremely  nervous  man,  he  was  a  very  sensible 
one,  and  I  was  able  to  completely  gain  his  con- 
fidence in  a  few  minutes,  and,  having  explained 
our  method  of  dealing  with  patients,  I  had  no 


TREATMENT  231 

further  trouble  with  him.  It  is  best  to  set 
your  patient's  mind  at  rest  before  he  has  time 
to  get  into  a  panic  through  his  fears. 

Having  gained  the  confidence  of  your  patient, 
removed  his  fears,  and  also  instructed  him  with 
regard  to  the  rules,  etc.,  and  having  administered 
the  preparatory  dose  of  drugs,  you  are  now  in  a 
position  to  commence  the  first  week's  treatment. 
Before  doing  this  I  will  mention  the  rules  and 
regulations  which  experience  has  taught  me  to 
be  necessary. 

Patients  were  expected  to  be  always  on  hand 
when  medicine  was  to  be  taken.  This  occurred 
six  times  a  day  ;  they  were  required  to  attend 
three  times  a  day  for  hypodermic  treatment. 
The  use  of  tobacco  in  any  form  but  the  pipe 
was  strictly  prohibited.  They  were  not  expected 
to  leave  the  grounds  for  the  first  three  or  four 
days,  unless  they  had  permission  to  do  so. 
Smoking  was  not  permitted  for  one  hour  before 
to  half  an  hour  after  the  hypodermic  treatment, 
and  a  very  moderate  use  of  the  pipe  recom- 
mended. The  other  rules  were  such  as  are  to  be 
found  in  all  well-conducted  homes.  I  have  no 
objection  to  patients  using  the  pipe  in  moderation, 
but  those  who  do  not  use  it  make  better  progress. 
The  use  of  the  pipe  close  to  treatment  time  has 
some  effect  upon  the  action  of  the  drugs,  which 


232  MODERN  TREATMENT  OF  ALCOHOLISM 

I  have  never  been  able  to  discover,  but  which 
is  quite  marked.  Cigars  are  prohibited  on 
account  of  their  well-known  effects  upon  the 
nerves.  Cigarettes  must  be  absolutely  barred 
if  you  wish  to  cure  your  patient.  I  only  know 
of  one  patient  out  of  over  2000  whom  I  have 
treated  who  was  cured  of  his  disease  after  per- 
sisting in  using  cigarettes.  He  w^as  an  excep- 
tionally strong-minded  man,  and  restricted  his 
smoking  to  one  a  day.  That  the  CO  pro- 
duced by  the  burning  of  the  wrapper  lessens  the 
oxygen-carrying  powers  of  the  red  blood  cor- 
puscles is  well  known,  but  why  it  should  nullify 
the  action  of  the  drugs  used  I  cannot  say.  That 
it  is  so  I  know,  and  I  am  so  convinced  of  this 
that  I  make  a  rule  of  dismissing  any  patient 
whom  I  find  persisting  in  the  use  of  cigarettes 
after  fair  warning.  Female  alcoholics  are  more 
difficult  to  cure  than  males,  but  the  female 
alcoholic  who  uses  cigarettes  is  the  most  difficult 
of  all  ordinary  alcoholics  to  cure,  for  the  simple 
reason  that  it  is  almost  impossible  to  get  her 
to  desist  from  their  use.  Further,  it  is  a  well- 
known  fact  that  many  periodical  alcoholics  who 
use  a  pipe  between  attacks  will  take  to  cigarettes 
just  before  an  attack  occurs.  Aside  from  the 
benefit  of  the  rules  to  the  patient,  their  necessity 
for  the  proper  conduct  of  a  home  has  another 


TREATMENT  233 

value,  which  is  a  very  important  one,  namely, 
they  enable  the  doctor  to  tell  whether  the  patient 
is  in  earnest  with  regard  to  his  cure  or  not.  If 
he  breaks  the  few  simple  rules  which  are  formed 
entirely  in  his  own  interests,  it  is  reasonable  to 
conclude  that  he  is  not  in  earnest  with  regard  to 
his  cure. 

The  question  of  the  condition  of  the  patient 
on  admission  is  an  important  one,  and  may  as 
well  be  discussed  here.  Friends  often  ask  if 
they  ought  to  keep  the  patient  at  home  until  he 
is  sober,  or  bring  him  while  he  is  drinking.  This 
depends  on  the  patient ;  if  he  is  likely  to  change 
his  mind  as  to  treatment  if  he  is  allowed  to  sober 
up  at  home,  it  is  advisable  to  start  treatment 
while  he  is  drinking ;  but  if  not,  it  is  far  better 
to  wait  until  he  is  sober,  as  it  is  more  pleasant 
for  all  concerned  at  the  sanatorium.  Otherwise 
it  does  not  matter. 

The  First  Week's  Treatment 

Having  decided  to  treat  the  patient  and 
having  gained  his  confidence,  explained  the  rules, 
etc.,  advised  him  carefully  and  administered  the 
preparatory  dose,  we  are  now  in  a  position  to 
administer  the  first  week's  treatment.  If  the 
patient  is  using  alcohol  at  the  time  of  admission, 


234  MODERN  TREATMENT  OF  ALCOHOLISM 

it  is  advisable  to  administer  sufficient  to  satisfy 
his  craving  for  it — the  amount  will  vary  with 
the  patient.  One  oz.  of  whisky,  diluted,  before 
each  meal,  with  one  at  bedtime,  will  generally 
be  found  sufficient ;  if  not,  there  is  no  harm  in 
giving  an  extra  ounce  or  so  between  meals.  I  find 
whisky  the  most  satisfactory  form  of  alcohol  to 
use.  Nothing  is  gained  by  varying  the  kind  of 
drink  in  the  majority  of  cases,  but  sometimes  this 
is  necessary.  I  will  refer  to  this  later  on.  If 
the  patient  has  been  drinking  much  just  before 
admission,  it  is  advisable  to  leave  4  oz.  with  the 
night  attendant  in  the  event  of  its  being  wanted. 
If  he  is  not  bad  enough  to  require  any  attendant 
it  may  be  left  with  the  patient  himself,  with 
instructions  to  use  it  if  he  feels  he  must.  The 
mere  fact  that  the  patient  knows  he  can  have  it 
if  he  wishes  often  sends  him  to  sleep  satisfied, 
when  otherwise  he  would  lie  awake  from  sheer 
nervous  dread  of  not  being  able  to  get  it.  There 
is  nothing  to  be  gained  by  cutting  off  the  alcohol 
suddenly,  while  much  harm  may  be  done.  I  know 
of  one  hospital  where  they  make  a  rule  of  refusing 
all  patients  any  alcohol  whatever  from  the  time 
of  their  admission  ;  the  average  of  deaths  from 
delirium  tremens  in  that  hospital  is  very  heavy 
indeed.  The  treatment  will  very  soon  regulate 
the  demand  for  the  stimulant  ;    a  few  hours  of 


TREATMENT  235 

treatment  and  the  patient  soon  loses  his  craving. 
I  have  seen  many  patients  who  would  take  any 
amount  offered  them  the  first  day,  who  could  not 
take  any  the  second  day.  In  four  or  five  days 
the  most  thirsty  will  refuse  it,  while  to  some  it  will 
become  absolutely  repulsive.  So  much  is  this  the 
case,  that  a  number  of  them  not  only  cannot  take 
it  themselves,  but  cannot  watch  others  take  it 
without  being  sick.  Therefore  we  need  have  no 
hesitation  in  letting  the  patient  have  enough  to 
satisfy  his  craving. 

For  the  first  week's  treatment  we  require  the 
following,  namely : 

One  good  hypodermic  syringe. 

A  supply  of  Schimmel's  needles  with  a  separate 

butt  for  each  patient. 
A  steriliser. 
One  pair  of  J-oz.  glass-stoppered  bottles  with 

wide  mouths  for  each  patient. 
Some  cotton-wool,  and  a  bottle  of  HgClg  in 

alcohol,  I  in  1000. 

The  bottles  should  be  labelled  with  the  patient's 
name  or  number,  each  patient  having  a  pair  to 
himself.  One  of  each  pair  of  bottles  will  contain 
a  solution  of  nitrate  of  strychnine,  the  other  a 
solution  of  sulphate  of  atropine.  It  will  be 
found  advisable  to  prepare  the  solutions  oneself. 
The  following  is  the  plan  I  have  found  the  least 


236  MODERN  TREATMENT  OF  ALCOHOLISM 

troublesome  and  most  satisfactory.  The  nitrate 
of  strychnine  is  carefully  weighed  into  4-grain 
powders.  One  of  these  is  placed  in  a  2-oz.  test- 
tube  (the  wider  the  tube  the  better,  as  a  narrow 
one  is  apt  to  boil  over)  and  9  drams  of  aqua  dist. 
is  gradually  added  in  such  a  way  as  to  com- 
pletely wash  down  any  crystals  of  the  strychnine 
which  may  be  adhering  to  the  side  of  the  tube. 
This  is  most  important,  as  one  may  learn  to  his 
cost  if  the  caution  is  neglected.  The  liquid  is 
well  boiled  for  three  or  four  minutes  in  order  to 
thoroughly  dissolve  the  strychnine  and  to  sterilise 
the  preparation.  The  solution  may  now  be 
cooled  at  once  by  allowing  cold  water  from  the 
tap  to  play  on  the  side  of  the  tube,  or  it  may  be 
set  aside  to  cool.  A  plug  of  cotton-wool  properly 
fired  should  be  placed  in  the  mouth  of  the  tube. 
When  cool  the  solution  should  be  filtered,  using 
two  filters.  Both  bottles  and  funnel  should  be 
thoroughly  sterilised.  The  preparation  should 
measure  exactly  i  oz.,  or  be  made  to  do  so  in  the 
ordinary  way.  It  is  important  that  the  prepara- 
tion should  not  be  filtered  while  hot.  No  pre- 
servative should  be  added,  for  it  is  far  better  to 
depend  entirely  upon  the  proper  sterilisation. 
The  sulphate  of  atropine  should  be  in  i -grain 
powders.  One  of  these  should  be  similarly 
placed   in   the   test-tube.     The  water  should  be 


TREATMENT  237 

sterilised  first,  then  cooled,  before  it  is  added  to 
the  drug.  Well  dissolve  in  cold  water  of  the 
strength  of  i  grain  to  i  oz.  If  the  patient  has 
been  prepared  for  treatment  he  is  given  three  in- 
jections daily  in  the  arm,  as  follows  :  A  pledget  of 
cotton-wool  is  wetted  with  the  solution  of  HgCU 
in  alcohol,  and  the  patient's  arm  well  rubbed 
with  it  at  the  point  where  it  is  intended  to  make 
the  injection .  Then  having  drawn  i  minim  of  each 
solution  into  the  syringe,  and  having  carefully 
excluded  all  air  from  it,  the  injection  is  made  in 
the  ordinary  way.  The  injections  are  given  just 
after  the  three  chief  meals.  The  dose  is  gradu- 
ally increased  during  the  week,  the  nitrate  of 
strychnine  rapidly  until  ^  of  a  grain  is  given 
at  each  injection  ;  the  sulphate  of  atropine  is 
pushed  till  the  physiological  effects  are  produced, 
namely,  dry  tongue  and  dilated  pupil.  It  is  not 
necessary  to  push  it  to  the  extent  of  producing 
delusions,  although  by  so  doing  a  still  better  effect 
is  produced,  but  the  comfort  of  all  concerned 
is  so  greatly  increased  by  not  doing  so  that  I  do 
not  think  the  results  warrant  it.  For  one  whole 
month  I  tried  excessive  doses  of  the  atropine,  with 
the  result  that  I  had  six  cases  of  delusions  in  one 
day  !  The  delusions  themselves  w^ere  harmless 
enough,  but  entailed  an  enormous  amount  of 
extra    work    and    strain   upon    the    staff.     Each 


238  MODERN  TREATMENT  OF  ALCOHOLISM 

patient  should  have  a  needle  and  a  small  bottle  of 
each  solution  set  aside  for  his  use  only.  The  rust- 
ing of  the  needle  when  in  the  steriliser  may  be 
avoided  by  placing  it  in  an  oil  bath.  If  these 
precautions  are  taken,  one  never  sees  the  smallest 
reaction  at  the  site  of  injection.  In  addition  to 
these  injections  the  following  mixture  is  ad- 
ministered six  times  a  dav  : 


Liq.  cinchona  (Fletcher) 

111^   X. 

Liq.  gentian 

,,    XV 

Liq.  rhei                  ,, 

,,  ii. 

Liq.  capsici             ,, 

Sulphate  atropine  sol. 

,,  ii. 

Nitrate  of  strychnine  sol. 

,,  ii. 

Glycerin  q.s. 

Aq.  to  I  oz. ; 

give  in  half  a  glass  of  water. 

In  order  to  administer  this  treatment  without 
confusion,  it  will  be  found  necessary  to  have  fixed 
hours  for  meals  and  treatment.  The  following 
will  answer  well : — Breakfast  at  8.30,  lunch  at 
I  o'clock,  tea  at  4.30,  and  dinner  at  7  o'clock. 
The  hours  for  medicine  would  be  8  and  10.30  a.m., 
12.30,  3,  6.30,  and  9.30  p.m.  Injections  at 
9.15  a.m.,  2  and  8  p.m. 

Diet  during  this  week  is  important.  Many  of 
the  patients  require  no  special  diet  ;  others 
regain  their   appetite   within   twenty-four  hours 


TREATMENT  239 

under  this  treatment.  With  regard  to  those 
who  cannot  take  ordinary  food  it  is  largely  a 
question  of  treatment  on  general  principles. 
Hot  Bovril  well  seasoned  with  pepper  is  useful. 
Milk  and  soda-water  or  milk  with  the  alcohol 
allowed  is  also  useful.  Horlicks'  malted  milk 
may  be  tried.  Sanatogen  will  often  be  found 
of  distinct  benefit  when  other  diet  fails.  Pre- 
digested  foods  of  various  makes  may  be  tried. 
In  persistent  vomiting  one  of  the  most  valuable 
remedies  is  freshly-prepared  lemonade ;  it  should 
be  made  strong  and  should  always  be  prepared 
from  fresh  ripe  lemons.  In  those  cases  where 
the  tongue  is  dry  and  thickly  coated,  with  a  small 
rapid  pulse  and  no  appetite,  it  sometimes  acts  with 
surprising  rapidity  and  is  well  worth  a  trial  in 
most  cases.  Where  there  is  gastric  tenderness 
with  vomiting  the  following  will  be  found 
useful : — 

Sodii  bicarb.       .         .         .         gr.  x. 
Bismuthi  carb.  .         .         .  ,,  x. 

Aq.  menth.  pip.  to     .         .         3    ss. 

every  six  hours. 

Sp.  ammon.  arom.     .         .         Tl]^  xv. 

may  be  added  to  this  if  the  pulse  is  weak.  The 
treatment  of  delirium  tremens  cases  will  be 
considered  later. 


240     MODERN  TREATMENT  OF  ALCOHOLISM 

Second  Week 

Having  reached  full  doses  of  the  injections 
during  the  first  week,  the  doses  should  be  main- 
tained throughout  the  second  week.  The  mixture 
should  be  given  as  in  the  first  week. 

The  Third  Week 

H  the  progress  of  the  patient  has  been  satis- 
factory, the  dose  of  the  atropine  is  now  rapidly 
reduced  until  the  sixteenth  day,  when  it  is  omitted 
from  the  injections.  At  the  same  time  the 
tincture  of  capsicum  is  withdrawn  from  the 
mixture. 

This  treatment  is  then  continued  during  the 
fourth  week.  At  the  beginning  of  the  fifth  week 
the  atropine  is  withdrawn  from  the  mixture, 
which  is  now  given  four  times  a  day  instead  of 
six ;  otherwise  the  treatment  is  administered 
as  before. 

During  the  sixth  week  the  strychnine  injections 
are  rapidly  reduced  until  nil,  and  are  only  given 
twice  a  day,  morning  and  evening.  At  the 
beginning  of  this  week  the  cinchona  is  also  with- 
drawn from  the  mixture,  the  latter  being  now 
given  three  times  a  day. 

I  have  now  outlined  the  course  of  treatment 


TREATMENT  241 

which  I  would  adopt  in  an  ordinary  straight- 
forward case  devoid  of  comphcations.  If  this 
were  all  we  had  to  do  in  order  to  cure  our  patients, 
the  matter  would  be  simple  enough,  but  un- 
fortunately it  is  not ;  much  more  must  be  done 
if  success  is  to  be  obtained.  It  is  quite  true  that 
the  above  treatment  faithfully  carried  out  will 
effect  a  cure  in  a  number  of  cases,  but  by  itself 
will  fail  in  many  others  which  ought  to  be  cured. 
In  1904  I  gave  an  outline  of  this  method  of  treat- 
ment in  the  British  Medical  Journal.  Judging 
by  my  correspondence,  it  was  evident  that  the 
treatment  was  being  tried  all  over  the  world. 
While  some  wrote  thanking  me  for  publishing 
the  treatment  and  stating  their  success,  others 
wrote  asking  why  they  had  failed  in  curing  their 
cases.  The  reason  must  be  obvious  to  all  thinking 
medical  men.  Alcoholism  is  a  disease  arising 
from  many  causes  and  associated  with  many 
complications,  and  a  thorough  knowledge  of 
the  subject  is  essential  to  success.  Patients 
must  be  studied  and  understood,  and  the  cause 
of  drinking  ascertained  in  each  case,  and  remem- 
bered throughout.  Personality,  tact,  and  judg- 
ment must  play  a  part.  It  is  not  to  be  expected 
in  this,  any  more  than  in  any  other  disease,  that 
routine  treatment  unaided  by  skill  and  experience 

will  be  successful.     Every  new  treatment  placed 
16 


242  MODERN  TREATMENT  OF  ALCOHOLISM 

before  the  medical  profession  has  had  to  go 
through  the  same  experience.  Many  try  these 
without  the  necessary  experience,  fail,  and  then 
condemn  the  whole  thing.  If  this  is  true  of  new 
treatment  in  ordinary  diseases,  how  much  more 
likely  is  it  to  be  the  case  in  such  a  complicated 
disease  as  alcoholism  ?  The  above  treatment 
may  be  termed  basal  treatment,  upon  which 
must  be  built  a  special  treatment  to  suit  each 
individual  patient's  requirements.  Skill  and 
experience  in  applying  the  treatment  must  be 
acquired  by  the  doctor  before  he  can  hope  for 
success  in  the  majority  of  cases,  and  it  is  for  this 
reason  that  the  treatment  can  never  be  as  success- 
ful in  the  hands  of  a  general  practitioner  as  when 
administered  in  a  home  by  one  who  makes  the 
subject  a  life-study.  There  are  many  cases  so 
situated  that  it  is  impossible  for  the  patient  to 
go  into  a  home,  and  the  general  practitioner 
must  necessarily  do  his  best  for  the  patient. 
These  I  wish  to  help  treat  their  cases  successfully 
so  far  as  it  lies  in  my  power,  but  if  they  fail  they 
must  not  blame  the  treatment  but  the  want  of 
the  necessary  skill  and  environment. 

Let  us  first  see  what  may  be  done  to  help  a 
patient  outside  the  routine  treatment.  Having 
classified  your  patient,  you  must  be  in  a  position 
to  know  the  cause  of  drinking.     Every  alcoholic 


TREATMENT  243 

has  an  internal  cause.  Is  there  also  an  external 
cause  ?  If  it  lies  in  your  power  to  remove  this, 
you  must  do  so.  If  it  is  in  the  power  of  his  friends 
to  do  this,  you  must  insist  upon  their  doing  so. 
In  order  to  cure  the  patient  it  is  not  enough 
to  remove  the  craving.  You  must  see  that  all 
inducement  to  indulge  is  removed  also,  if  possible. 
Therefore  every  effort  must  be  made  to  leave 
your  patient  as  little  handicapped  as  possible 
in  the  fight  which  he  will  have  to  make.  Let  us 
take  an  instance  to  show  what  I  mean.  A  man 
oversteps  the  boundary  in  social  drinking  two 
or  three  times.  His  wife  is  unwise  in  her  method 
of  remonstrance.  The  result  in  some  cases  is 
to  arouse  opposition,  together  with  a  determina- 
tion to  persist  in  his  course.  After  a  time  he 
develops  a  craving ;  he  is  soon  incapable  of 
stopping  without  help,  but  the  wife  has  no  means 
of  knowing  this.  Treatment  will  remove  the 
craving,  but  the  wife  must  be  shown  where  she 
made  the  mistake,  and  instructed  how  to  help 
rather  than  hinder  in  the  future.  If  such  a 
patient  returns  to  a  home  where  he  will  be 
constantly  reproached  with  the  past,  unless  he 
is  an  exceptionally  strong-minded  man,  and  has 
his  lesson  well  learned,  he  is  sure  to  relapse. 
Let  the  wife  learn  the  real  nature  of  alcoholism, 
and  in  nine  out  of  ten  cases  she  will  help  instead 


244  MODERN  TREATMENT  OF  ALCOHOLISM 

of  hindering.  What  appUes  to  the  wife  appHes 
equally  to  parents,  relations,  and  friends.  Advice 
here  may  make  all  the  difference  between  success 
and  failure.  I  have  seen  many  cases  corrobor- 
ative of  the  above.  There  is  another  direction 
in  which  something  more  than  treatment  is 
required.  Let  me  illustrate  this  by  an  object- 
lesson  which  I  met  with  early  in  my  career  as  a 
specialist.  I  was  in  a  lift  in  a  public  building, 
which  also  contained  a  very  frowsy -looking  man. 
Now  doctors  are  sufficiently  experienced  in  such 
cases  to  enable  them  to  meet  them  without 
showing  their  disgust,  but  this  unfortunate  man 
was  so  exceptionally  dirty  and  unkempt,  that  I 
shrank  into  the  farthest  corner  of  the  lift  from 
him.  Half  an  hour  later  my  friend  to  whom  I 
had  related  my  experience  gave  me  the  man's 
history,  and  asked  me  if  I  would  undertake  his 
treatment.  His  history  was  a  very  sad  one.  He 
had  once  been  a  prosperous  merchant,  but  drink 
had  gripped  him  at  the  death  of  his  wife.  Failing 
to  master  the  craving,  he  showed  his  noble 
disposition  by  converting  the  remainder  of  his 
funds  into  an  annuity  for  his  daughter,  which 
would  ensure  her  from  want  and  provide  for  her 
education.  He  then  left  for  Canada,  wliere  he 
hoped  to  make  a  fresh  start  in  life,  but  with  the 
result  too  often  met  with.     He  told  me  that  his 


TREATMENT  245 

position  had  become  so  intolerable  to  him  that 
he  had  tried  several  times  to  take  his  own  life, 
but  never  could  find  sufficient  courage  to  take 
the  fatal  plunge.  The  problem  which  imme- 
diately presented  itself  to  my  mind  was — what 
is  to  be  done  with  such  a  man  after  treatment  ? 
He  was  absolutely  devoid  of  all  prospects  for  the 
future.  I  considered  it  useless  to  treat  such  a 
man,  and  then  consign  him  to  misery  and  want. 
My  friend  then  undertook  to  see  that  he  would 
get  a  fresh  start  after  treatment.  He  was 
cleansed,  robed,  and  treated  ;  he  was  then  given 
a  new  start  in  Hfe.  Some  months  later  I  met  a 
well-dressed,  prosperous-looking  man,  whose  face 
I  could  not  place  although  it  seemed  familiar  to 
me.  He  stopped  me  and  told  me  who  he  was  ;  I 
could  hardly  credit  the  fact  that  the  well-dressed, 
genial-looking  man  before  me  was  that  same 
man  from  whom  I  had  shrunk  in  the  lift.  I 
accepted  an  invitation  to  visit  his  rooms,  and 
was  both  astonished  and  pleased  with  what  I  saw. 
Good  taste  and  refinement  was  evident  every- 
where. This  was  the  man  who  had  been  brought 
so  low  by  drink  that  he  had  been  sleeping  for 
months  on  filthy  straw  in  a  disused  stable, 
unkempt,  unwashed,  and  dressed  in  filthy  rags. 
It  was  as  necessary  to  give  him  a  start  in  life  as  to 
give  him  the  treatment.     There  is  a  part  for  the 


246  MODERN  TREATMENT  OF  ALCOHOLISM 

doctor  to  do  and  a  part  for  the  friends  to  do  ; 
the  doctor  cannot  do  it  all  and  the  friends  cannot 
do  it  all ;  they  must  join  forces  if  they  wish  to 
be  successful. 

I  make  it  a  practice  to  have  an  hour's  talk 
with  each  patient  during  his  treatment,  in  order 
to  point  out  the  object  and  end  of  the  treatment, 
to  warn  him  of  the  pitfalls  ahead,  and  to  give 
him  such  general  advice  as  I  consider  most  useful 
to  him.  The  nature  of  this  advice  will  be  evident 
when  I  come  to  describe  the  results  of  the  treat- 
ment. 

Let  us  now  follow  an  ordinary  case  through 
the  course  of  treatment  and  see  what  happens. 
The  patient  will  in  three  or  four  days  lose  all  desire 
for  alcohol,  and  will  of  his  own  accord  cease 
drinking.  By  the  end  of  the  first  week  he  will, 
be  sleeping  well,  and  eating  with  a  very  fair 
appetite.  By  the  end  of  the  second  week  his 
nervousness  will  be  gone  in  most  cases,  and  there 
will  be  still  better  appetite  and  sounder  sleep. 
From  this  onwards  there  ought  to  be  a  steady  and 
rapid  improvement  in  all  directions,  and  during 
this  time  he  has  had  practically  no  curtailment 
of  his  liberty. 

Let  us  now  look  at  a  somewhat  different  case. 
We  will  presume  that  the  patient  is  under  treat- 
ment, but  has  not  quite  made  up  his  mind  that 


TREATMENT  247 

he  wishes  to  be  cured.  Nothing  may  occur  to 
indicate  this  until  during  the  second  week  it  is 
felt  that  the  patient  is  not  making  the  progress 
he  ought  to  be  making.  There  are  always  indi- 
cations of  this  to  the  experienced  eye.  The 
patient  is  then  watched,  and  found  to  be  tamper- 
ing with  alcohol.  The  question  at  once  arises — 
Are  you  to  refuse  further  treatment  or  try  special 
means  to  save  him  ?  I  am  always  in  favour  of 
the  latter,  as  experience  has  shown  me  that  many 
good  cures  have  been  made  in  such  cases.  The 
first  thing  to  do  is  to  find  out  the  reason  why  the 
patient  is  acting  thus.  Some  patients  imagine 
that  they  are  going  to  be  able  to  drink  in  moder- 
ation. Any  such  idea  must  be  corrected  at 
once.  Some  patients  make  an  experiment  during 
treatment  in  order  to  see  if  they  can  drink. 
These  should  be  warned  against  such  practices, 
and  told  to  await  the  result  of  the  treatment. 
Then  there  is  the  patient  who  will  openly  ask  to 
be  cured,  secretly  determining  not  to  be  cured. 
Where  advice  fails  the  following  may  save  the 
patient  :  rapidly  push  the  atropine  until  -V^h 
grain  is  given  three  times  a  day,  and  insist  upon 
the  patient  taking  several  heavy  drinks  of  his 
favourite  form  of  alcohol.  He  will  probably  be 
very  sick,  and  nothing  more  may  be  required. 
If  he  should  not  be  sick,  it  is  as  well  to  ensure 


248  MODERN  TREATMENT  OF  ALCOHOLISM 

his  being  so  by  giving  an  injection  of  apomorphine 
just  before  he  is  given  a  drink.  This  may  be 
repeated  two  or  three  times  in  obstinate  cases. 
Sometimes  this  has  the  happiest  result.  One  of 
the  best  cures  I  ever  made  was  a  man  to  whom 
I  liad  to  administer  tliis  treatment  three  separate 
times.  He  afterwards  told  me  that  he  drank 
from  sheer  determination  to  defeat  my  efforts  to 
cure  him.  He  has  now  been  cured  twenty  years, 
and  never  meets  me  without  telling  me  how 
thankful  he  is  that  I  did  not  give  him  up.  With 
others  it  will  fail ;  these  are  always  mixed  cases 
in  which  the  vice  greatly  exceeds  the  disease, 
and  it  is  hopeless  to  expect  a  cure  at  this  stage 
of  their  drinking.  Later  on  in  life,  when  the 
disease  has  progressed  to  a  greater  degree,  they 
will  be  glad  to  avail  themselves  of  the  treatment. 

Other  patients  will  present  themselves  for 
treatment,  whose  physical  condition  is  such  as 
to  call  for  special  treatment.  For  instance,  the 
cause  for  drinking  in  some  families  is  found  to  be 
a  diseased  condition  of  the  sexual  organs.  Obvi- 
ously this  must  be  corrected  if  we  wish  to  succeed. 
Others  will  be  found  to  be  suffering  from  neuras- 
thenia ;  one  of  the  most  potent  remedies  here  is 
high  frequency.  Twenty  minutes  a  day  on  the 
condensation  couch  for  three  or  four  weeks  will 
make  all  the  difference  between  success  and  failure. 


TREATMENT  249 

Certain  gastric  conditions  are  sometimes  found 
to  be  causes  of  drinking.  High  frequency  here 
also  proves  to  be  of  the  greatest  value.  In 
others  chronic  rheumatism  and  neuritis  will  often 
yield  to  this  form  of  treatment.  In  fact,  every 
means  must  be  resorted  to  in  order  to  remove 
any  ascertained  cause. 

The  Treatment  of  Delirium  Tremens 

I  have  already  stated  how  this  may  be  pre- 
vented in  many  cases,  but  sometimes  we  must 
deal  with  it.  I  do  not  agree  with  the  late  Norman 
Kerr  that  it  is  safe  to  at  once  cut  off  all  alcohol. 
I  am  convinced  that  many  cases  of  delirium 
tremens  are  thus  precipitated  which  might  have 
been  obviated.  Some  patients  arrive  in  this 
condition.  Three  things  must  be  aimed  at, 
namely,  reducing  the  cerebral  congestion,  feeding 
the  patient,  and  inducing  sleep.  If  the  cardiac 
condition  will  permit  it,  the  purgative  treatment 
already  mentioned  should  be  administered. 
Whatever  alcohol  is  given  should  be  given  in  milk, 
and  feeding  along  the  lines  already  mentioned 
should  be  tried.  To  induce  sleep  it  is  useless  as  a 
rule  to  administer  drugs  by  the  mouth.  Very 
often  they  are  not  absorbed  for  hours,  and  then  if 
repeated  doses  have  been  given  one  may  have  to 


250  MODERN  TREATMENT  OF  ALCOHOLISM 

deal  with  a  case  of  poisoning.  One  of  the  best 
and  safest  methods  is  to  give  a  hypodermic 
injection  of  morphia,  one-half  a  grain,  with  ^y^oth 
of  a  grain  of  hyoscin.  This  will  often  produce  a 
calm  sleep  for  hours.  The  patient  will  wake  up 
quite  rational,  especially  if  he  has  been  well 
purged  as  above.  Apomorphine  is  a  drug  which 
has  lately  gained  a  considerable  reputation  for 
its  effect  in  these  cases.  It  should  be  injected  in 
one-half  the  ordinary  doses.  I  think  it  has  a 
future  before  it.  I  also  think  the  smaller  doses 
have  as  great  an  effect  as  the  larger  doses,  and 
there  is  less  risk  of  straining  the  already  weak 
heart.  One  has  always  to  remember  that  fatty 
degeneration  of  the  heart  is  often  a  complica- 
tion in  these  cases.  As  soon  as  the  patient  has 
become  rational  the  ordinary  treatment  may  be 
given. 

We  now  come  to  the  question  of  proper  diet. 
This  treatment  develops  a  remarkable  appetite, 
and  the  tendency  is  for  patients  to  eat  too  much. 
Therefore  the  meals  should  be  plain  with  plenty 
of  fruit.  Oatmeal  porridge  and  fruit  should  be 
part  of  every  breakfast.  This  wall  help  to  correct 
any  excesses.  Too  much  meat  is  not  advisable, 
and  it  is  as  well  to  omit  such  vegetables  as  cause 
indigestion.  In  the  warm  weather  plenty  of 
lemonade  should  be  served  ;   there  should  always 


TREATMENT  251 

be  apples,  oranges,  or  grapes  at  dinner.  Pickles 
and  highly-spiced  sauces  should  be  omitted ; 
suppers  should  not  be  allowed  during  treatment, 
even  though  the  patient  has  always  been  used  to 
them.  What  virtue  there  may  be  in  fruit  beyond 
its  cooling  effect  upon  the  blood  and  its  regulating 
effect  upon  the  system,  I  am  not  prepared  to  say. 
Some  claim  that  it  has  a  stimulating  effect  as  well ; 
this  I  think  is  true,  but  of  one  thing  I  arti  certain, 
and  that  is  that  patients  do  better  on  fruit  than 
without. 

Exercise  should  be  very  light  for  the  first  ten 
days,  as  the  patient  is  easily  fatigued  at  this  time. 
During  the  rest  of  the  treatment  he  should  take 
plenty  of  exercise  every  day  if  he  is  inclined  to 
avoid  it  ;  every  day  he  should  be  asked  to  walk 
a  certain  distance,  or  if  the  weather  is  unfit  for 
walking  a  game  of  billiards  will  help,  but  the 
patient  should  not  be  allowed  to  sit  about  too 
much.  Gardening  in  moderation  is  an  excellent 
form  of  exercise  if  the  patient  can  be  induced  to 
take  an  interest  in  it. 

If  you  wish  to  do  the  patient  the  most  good, 
get  into  sympathetic  touch  with  him  at  the  very 
beginning  of  his  treatment.  Morally  he  will  be 
a  lame  dog  for  the  first  two  or  three  weeks,  and 
will  need  helping  over  many  stiles  before  this 
lameness    leaves    him.     When    he    understands 


252  MODERN  TREATMENT  OF  ALCOHOLISM 

that  you  have  a  sincere  kindly  interest  in  his 
welfare  he  will  readily  listen  to  your  advice. 
The  personal  element  must  enter  very  largely 
into  the  question,  from  the  very  nature  of  the 
disease.  Much  more  depends  upon  the  personal 
character  of  the  doctor  administering  the  treat- 
ment than  might  be  supposed.  This  is  an 
important  point  and  well  worth  while  looking 
into.  Let  us  suppose  that  two  doctors  are 
treating  two  alcoholic  patients  of  an  exactly 
similar  type.  The  patient's  history  is  correctly 
taken  and  recorded — the  treatment  is  precisely 
administered  throughout.  The  doctor  is  uni- 
formly courteous  to  his  patient  ;  he  may  even  be 
of  a  statistical  turn  of  mind  and  keep  a  perfect 
record  of  history — doses,  pulse,  temperature,  etc. ; 
but  he  fails  to  cure  his  patient.  The  other  doctor 
has  a  similar  patient  to  treat ;  he  estabhshes  a 
sympathetic  bond  between  the  patient  and 
himself  during  the  first  hour  the  patient  is  with 
him.  From  that  moment  to  the  completion  of 
the  treatment  the  patient  will  be  led  to  see  that 
the  doctor  takes  a  deep  interest  in  him,  and  is 
sincerely  anxious  to  make  his  case  a  success. 
This  induces  the  patient  to  confide  in  the  doctor, 
with  the  result  that  the  doctor  is  able  to  do  much 
more  for  him  than  otherwise  would  be  the  case. 
The  patient's  troubles,  faihu-es,  and  weaknesses 


TREATMENT  253 

are  laid  bare,  enabling  the  doctor  to  give  him  the 
advice  and  help  which  is  so  necessary  to  success. 
His  suggestions  and  advice  are  well  received  and 
followed,  and  he  cures  his  patient.  The  personal 
element  alone  has  decided  the  result. 

Doctors  have  often  asked  me,  "Do  you  use 
suggestion  as  a  means  of  curing  your  patients  ?  " 
Most  doctors  use  suggestion  in  the  treatment  of 
their  cases,  deliberately  or  otherwise  ;  it  is  a 
valuable  aid,  but  is  not  a  main  factor  in  the 
treatment.  That  cases  can  be  cured  without 
any  suggestion  the  following  will  well  illustrate. 
Some  years  ago  the  family  physician  of  a  wealthy 
patient  asked  me  if  I  would  undertake  charge  of 
the  case,  but  expressed  a  wish  that  the  object  of 
the  treatment  should  not  be  disclosed  to  the 
patient.  To  this  I  assented,  and  I  was  introduced 
as  a  nerve  specialist.  The  patient  was  to  be 
treated  in  his  own  home.  Thinking  this  an 
excellent  occasion  for  testing  the  part  played 
by  drugs  alone,  I  deliberately  refrained  from 
making  any  suggestion  whatever.  The  patient 
had  been  drinking  to  excess  daily  for  months,  and 
had  not  left  the  house  during  that  time.  He 
would  lie  all  day  on  a  lounge  with  a  bottle  of 
whisky  and  syphon  of  soda  by  his  side,  and  was 
never  sober.  I  decided  to  let  him  do  as  he  pleased, 
providing  he  would  allow  me  to  administer  the 


254  MODERN  TREATMENT  OF  ALCOHOLISM 

treatment.  Telling  him  that  his  nerves  were  out 
of  condition,  I  asked  him  if  he  would  permit  me 
to  try  and  put  them  in  order.  Having  obtained 
his  consent  to  this,  and  having  made  friends  with 
him,  I  commenced  treatment.  On  the  third  or 
fourth  day  I  noticed  that  he  was  quite  sober,  and 
that  the  whisky  and  soda  had  disappeared.  The 
next  day  it  was  still  missing,  and  I  said  to  him,  "  I 
notice  that  you  are  not  taking  any  alcohol  now  ! 

How  is  that  ?  "     "  Oh  !    I  had  to  send  the  d 

thing  away.  The  very  sight  of  it  made  me  sick. 
Even  to  think  of  it  makes  me  feel  ill."  That  was 
the  last  drink.  It  was  not  till  the  last  week  of 
treatment  that  he  found  out  what  he  was  being 
treated  for.  Now  this  was  not  a  case  of  periodical 
alcoholism.  With  regard  to  suggestion  I  may  say 
that  I  use  it  as  an  aid  to  drug  treatment,  and  often 
find  it  of  great  help  in  cases  of  weak  will-power, 
but  I  have  no  experience  of  its  use  by  itself  as  a 
cure  for  alcoholism.  I  can  quite  understand  its 
being  of  the  greatest  help  in  cases  of  class  4. 

The  Treatment  of  Periodical  Alcoholism 

The  first  consideration  is,  when  should  the 
patient  be  treated — during  the  attack  or  between 
the  attacks  ?  With  regard  to  results,  I  do  not 
think  it  matters   much  which   plan   is   adopted. 


TREATMENT  255 

This  being  so,  it  is  highly  desirable  to  have  the 
patient  come  for  treatment  between  attacks. 
This  is  generally  a  difficult  matter,  as  these  patients 
invariably  insist,  on  recovery  from  their  attack, 
that  they  never  intend  to  touch  it  again,  and  they 
are  most  difficult  to  persuade  to  the  contrary  ; 
hence  the  difficulty  of  getting  them  to  take  treat- 
ment when  sober.  As  a  result,  the  majority  of 
cases  are  treated  towards  the  end  of  an  attack. 
The  treatment  recommended  for  class  i  will  be 
found  equally  useful  in  these  cases,  but  the  doctor 
in  charge  will  be  confronted  with  a  difficulty  which 
does  not  obtain  in  the  treatment  of  class  i .  He  has 
no  index  of  the  effect  of  the  treatment  upon  the 
craving,  for  it  must  be  remembered  that  these 
patients  have  no  craving  between  the  attacks. 
In  many  cases  they  have  a  well-marked  feeling 
of  revulsion  with  regard  to  alcohol.  While  in 
class  I  the  effect  of  the  treatment  may  be  readily 
watched,  here  the  doctor  has  no  guide  whatever. 
Perhaps  I  ought  not  to  go  so  far  as  this  ;  it  would 
be  better  to  limit  that  statement  to  those  who 
have  only  a  moderate  experience  in  the  treatment 
of  alcoholism,  for  those  of  long  experience  acquire 
a  faculty  of  determining  the  progress  of  the 
patient  in  these  cases.  This  change  has  to  do 
with  his  physical  progress.  It  is  very  difficult  to 
explain  what  it  is,  but  it  is  there  in  all  successful 


256  MODERN  TREATMENT  OF  ALCOHOLISM 

cases,  and  it  is  not  in  all  others.  In  class  i  the 
destruction  of  the  craving  is  alwa37S  accompanied 
by  an  improvement  in  the  moral  fibre  of  the 
patient.  One  would  naturally  expect  a  similar 
improvement  in  cases  of  class  2,  where  the  cure 
was  working  satisfactorily.  This  may  have 
something  to  do  with  it,  but  if  it  has,  the  change  is 
so  delicate  in  nature  that  it  is  not  obvious  to  men 
who  have  not  been  trained  to  look  for  it.  It  is 
well  to  remember  that  these  patients  are  the 
most  optimistic  of  all  alcoholics,  and  their 
assurances  must  be  well  weighed  and  discounted 
heavily.  There  is  one  feature  of  these  pa,tients 
about  which  I  would  like  to  say  a  word. 
After  an  attack  has  run  its  course,  the  patient 
suddenly  announces  his  intention  of  reforming, 
and  takes  great  credit  to  himself  for  this  resolu- 
tion. His  friends  are  delighted,  and  are  led  once 
more  to  believe  in  his  promises.  These  sudden 
resolutions  by  a  sobering  up  of  the  patients  have 
led  many  loving  wives  and  fond  parents  to 
persevere  in  their  efforts  of  reclamation,  deluding 
themselves  that  they  are  conquering  the  disease 
and  will  eventually  save  the  patient.  As  a 
matter  of  fact  they  are  doing  the  patient  a  great 
harm,  possibly  by  delaying  his  treatment  and 
running  the  risk  of  his  becoming  incurable.  The 
patient's  resolution  to  sober  up  is  not  genuine, 


TREATMENT  257 

for  the  disease  itself  forces  him  to  stop  drinking. 
The  drink  becomes  repulsive  to  him,  he  can  no 
longer  take  it,  and  so  decides  to  save  his  face  ; 
by  his  false  resolution  he  deceives  his  friends,  but 
not  his  doctor.  As  soon  as  the  craving  returns 
he  will  drink  again  as  surely  as  the  sun  will  rise, 
and  the  craving  will  return  just  as  surely,  unless 
it  is  destroyed  by  a  proper  treatment  meantime. 

Class  4. — I  have  already  pointed  out  that  alco- 
holics coming  under  this  description  are  not  fit 
subjects  for  medical  treatment ;  there  is  no  craving 
to  remove.  It  is  with  this  class  of  patient  that 
the  wife,  parents,  friends,  or  pastor  may  succeed ; 
certainly  it  is  their  work  and  not  the  doctor's. 
Here  I  should  emphasise  the  statement  I  have 
already  made,  that  it  is  not  only  senseless  and 
useless  to  lock  these  patients  up,  but  positively 
harmful.  To  punish  a  man  for  any  offence  com- 
mitted against  the  law  as  to  his  drinking,  is 
quite  another  thing,  but  to  attempt  to  cure  him 
by  locking  him  up  is  sheer  nonsense.  The  results 
of  all  our  efforts  in  this  direction  amply  prove 
this.  I  am  now  referring  only  to  those  members 
of  this  class  who,  without  the  slightest  excuse, 
deliberately  get  drunk.  But  there  is  another 
section  of  this  class  whose  treatment  must  be 
different  ;  I  refer  to  those  who  drink  from  sheer 
misery.  They  have  no  craving  to  remove,  but 
17 


258  MODERN  TREATMENT  OF  ALCOHOLISM 

there  is  a  definite  cause.    If  this  cause  is  removed, 
they  cease  to  drink. 

We  now  come  to  describe  the  treatment 
of  class  3.  Dipsomaniacs  cannot  be  satisfac- 
torily treated  without  restraint — the  risk  is  too 
great  both  to  the  doctor  and  the  patient.  I 
have  nearly  lost  my  life  on  several  occasions 
through  attempting  to  treat  these  patients  with- 
out proper  restraint.  It  is  necessary  to  re- 
member that  although  the  mania  has  been  brought 
on  by  drink,  it  does  not  differ  from  mania  due 
to  other  causes.  The  patient  may  be  either 
homicidal  or  suicidal.  If  the  patient  can  be 
induced  to  take  treatment,  it  should  be  on  the 
distinct  understanding  that  he  may  be  deprived 
of  his  liberty  whenever  necessary ;  and  for  this 
reason  the  treatment  ought  to  be  carried  out  in  a 
properly  equipped  home,  where  a  padded  room 
and  strait-jacket  are  convenient.  In  the  absence 
of  mania,  the  treatment  will  be  similar  to  that  in 
class  I.  If  an  attack  of  mania  comes  on,  the 
routine  treatment  must  be  suspended,  and  every 
effort  made  to  control  the  excitement.  A 
purgative  dose  of  calomel  must  be  given  at  once, 
followed  in  eight  hours  by  a  saline  cathartic. 
Whatever  theory  we  accept  as  to  the  cause,  such 
a  preparation  has  a  most  marked  effect.  Aside 
from  this,  we  thereby  prepare  the  way  for  any 


TREATMENT  259 

further  treatment.  To  control  the  excitement, 
we  may  resort  to  several  drugs.  The  bromides  are 
often  useful  if  pushed  sufficiently,  but  I  should 
not  advise  the  use  of  any  of  the  mixtures  of 
bromides  combined  with  other  more  powerful 
sedatives,  as  this  limits  the  dose  of  the  bromides. 
Bromidia  is  one  of  these  preparations  to  which 
I  have  given  an  extended  trial.  In  slight  cases 
it  acts  very  well,  but  I  had  an  unpleasant  ex- 
perience several  times  on  finding  it  increased  the 
excitement  even  when  pushed  to  the  limit.  With 
the  plain  bromide  one  has  practically  no  limit 
to  the  dose  one  may  find  necessary  to  adminster. 
One-half  grain  of  morphine  with  o^th  grain 
strychnine  is  often  very  successful.  Veronal  is 
one  of  the  safest  of  its  class  ;  if  this  is  tried,  it  is 
as  well  to  remember  that  veronal  itself  must  be 
dissolved  in  boihng  water  before  administration 
unless  the  sodium  veronal  is  used  ;  otherwise  it 
will  not  act  for  many  hours  afterwards,  as  it 
dissolves  very  slowly  in  the  system. 

Hyocine  is  another  useful  drug,  either  alone 
or  in  combination  with  morphine,  but  it  must  be 
used  with  great  caution. 

Perhaps  the  most  promising  drug  we  have  is 
apomorphine,  but  I  do  not  find  it  necessary  to 
administer  the  large  doses  recommended  by 
others.     ^Vth    gr.    repeated    when    necessary    is 


26o  MODERN  TREATMENT  OF  ALCOHOLISM 

quite  as  successful,  and  much  less  risky.  It  sliould 
be  tried  in  all  cases  where  the  cardiac  symptoms 
do  not  contra-indicate  its  use.  Again,  it  is  well  to 
remember  that  in  all  alcoholics,  remedies  which 
produce  heart-strain  must  be  used  with  great 
caution. 

I  have  seen  suggestion  act  in  some  cases  in  the 
most  striking  way.  Owing  to  the  great  age  of 
a  patient  and  cardiac  comphcations,  I  was  much 
limited  in  the  use  of  sedatives,  and  I  decided  to 
try  suggestion.  Seizing  his  hands,  I  suggested 
sleep,  with  all  the  concentration  of  mind  I  could, 
and  to  my  astonishment  the  patient  was  sound 
asleep  in  two  or  three  minutes.  His  sleep 
lasted  for  twenty-four  hours,  during  which  time 
he  was  aroused  every  eight  hours  in  order  to  ad- 
minister nourishment,  when  he  would  immedi- 
ately drop  off  to  sleep  again.  It  was  somewhat 
remarkable  that  he  slept  the  exact  time  I  sug- 
gested he  should  ;  but  how  much  of  this  was 
due  to  suggestion  and  how  much  to  the  drugs 
administered,  I  am  not  in  a  position  to  say.  I 
have  often  used  suggestion,  but  never  with  such 
striking  success  as  in  this  case.  I  will  go  further, 
and  say  that  I  have  found  it  of  such  value  in  the 
treatment  of  alcoholism  at  various  stages  and 
for  various  purposes  that  I  consider  it  essential 
to   success   in   many   cases.     This   applies   more 


TREATMENT  261 

particularly  to  the  mixed  cases  where  vice  and 
disease  go  hand  in  hand.  In  these  cases  it  is 
necessary  to  do  more  than  remove  the  craving, 
and  drug  treatment  and  suggestion  must  go 
together.  I  am  convinced  that  suggestion  alone 
will  not  succeed  with  these  patients,  and  I  am 
equally  convinced  that  drug  treatment  by  itself 
will  likewise  fail.  Patients  vary  in  their  suscepti- 
bihty  to  suggestion.  The  effect  on  some  is 
slight,  while  on  others  it  is  very  marked.  In 
one  case  I  could  control  the  patient  at  a  distance 
— quite  as  well  a  mile  away  as  close  by. 

General  Results  of  the  Treatment 

We  now  come  to  the  consideration  of  the 
results  of  the  treatment.  During  the  first 
week  the  patient's  craving  for  alcohol  dis- 
appears entirely,  so  that  he  may  be  allowed 
complete  freedom.  For  many  years  I  made 
it  a  rule  to  give  the  patient  a  4-oz.  bottle  of 
whisky  to  take  to  his  room  at  night,  with  in- 
structions to  use  it  if  he  felt  so  inclined.  The 
percentage  of  patients  in  which  it  was  used  was 
small,  and  that  always  during  the  first  week.  The 
object  of  this  was  twofold.  Many  patients  have 
been  so  long  depending  on  alcohol  in  order  to  get 
to  sleep  that  it  is  not  easy  to  convince  them  that 


262  MODERN  TREATMENT  OF  ALCOHOLISM 

they  can  sleep  without  it,  and  the  mere  fact  that 
they  have  it  by  them,  in  case  of  need,  will  be 
sufficient  to  quieten  their  nerves,  and  so  content 
them  that  they  will  go  to  sleep  without  it  ;  once 
they  are  able  to  experience  this  they  no  longer 
require  it.  It  also  is  a  fairly  reliable  test  of  the 
progress  in  regard  to  the  craving  ;  the  craving 
not  only  disappears  rapidly,  but  in  quite  a  large 
proportion  of  cases  it  is  followed  by  a  most 
marked  aversion  to  alcohol.  I  have  seen  emesis 
produced  in  a  patient  instantly  by  merely  seeing 
another  patient  taking  a  drink.  This  is  excep- 
tional, but  many  patients  feel  like  vomiting  if 
they  smell  the  fumes  of  alcohol,  and  some  actually 
do  so.  Other  patients  who  have  witnessed  this 
are  made  uneasy  in  their  minds,  believing  that 
the  treatment  has  not  been  successful  in  their 
case,  because  they  do  not  experience  a  similar 
feeling.  When  they  have  consulted  me  about  it 
they  always  admit  that  they  have  no  desire  for  the 
alcohol,  but  feel  that  they  could  take  a  drink 
without  its  making  them  sick.  I  always  advise 
them  not  to  try  it,  but  to  leave  time  to  do  the 
work.  I  give  this  advice  for  two  reasons,  namely, 
there  are  some  patients  in  whom  this  result  does 
not  occur,  and  it  would  be  very  unwise  for  such 
to  take  alcohol.  If  it  did  not  make  them  sick, 
and  they  were  of  tlie  class  which  finds  one  drink 


TREATMENT  263 

sets  their  blood  on  fire,  the  result  might  be  un- 
pleasant. The  second  reason  is  the  fact  that 
many  of  these  patients  find  out,  later  on,  that 
their  revulsion  to  alcohol  is  present  in  their 
system.  The  following  will  illustrate  what  I 
mean.  A  patient  was  telling  me  that  he  had  not 
experienced  this  feeling  of  revulsion  to  alcohol, 
and  was  quite  concerned  about  it.  I  had  just 
advised  him  to  leave  it  to  time,  when  he  poured 
himself  a  glass  of  w^ater,  the  weather  being  very 
hot,  drank  it — and  immediately  he  was  sick.  I 
took  up  the  glass  and  smelt  it  ;  he  had  used  a 
glass  which  had  contained  alcohol.  Five  minutes 
before  the  patient  had  assured  me  that  he  had  no 
aversion  to  alcohol,  yet  the  effect  of  drinking 
water  out  of  an  empty  glass  which  had  contained 
it  was  to  make  him  sick,  and  so  much  so  that  he 
could  not  eat  any  food  for  tw^enty-four  hours. 
Having  met  with  many  such  instances  of  the 
intolerance  being  there  without  the  patient's 
knowledge  of  it,  I  always  advise  them  to  let  time 
tell  the  tale.  This  intolerance  is  not  a  passing 
one,  but  is  permanent,  for  it  will  be  operative 
many  years  afterwards.  The  administration  of 
the  treatment  should  aim  at  obtaining  the 
greatest  degree  of  intolerance  possible.  It  is  not 
sufficient,  in  some  cases,  to  produce  a  condition 
in  which  the  patient  merely  feels  he  does  not  wish 


264     ]\10DERN  TREATMENT  OF  ALCOHOLISM 

for  alcohoL  The  treatment  must  be  pushed 
until  he  feels  not  only  that  he  does  not  want  it, 
but  that  he  could  not  take  it  if  he  tried.  This 
can  be  done  in  a  large  percentage  of  cases,  if  the 
treatment  is  properly  administered. 

With  regard  to  sleep,  it  is  astonishing  how  soon 
natural  sleep  comes  back  to  the  patient  when 
taking  the  treatment.  In  95  per  cent,  of  cases  I 
never  have  to  administer  a  sleeping  draught  ;  it 
is  almost  a  routine  expression  of  patients,  after 
about  three  days'  treatment,  "  I  have  not  slept 
so  well  for  months."  In  some  this  is  so  marked 
that  they  sleep  one-half  the  day  as  well  for  the 
first  week  or  two. 

What  has  been  said  about  sleeping  applies 
equally  well  with  regard  to  appetite.  Many 
patients  will  take  the  first  good  breakfast  for 
years  on  the  second  or  third  day  of  their  treat- 
ment, and  pass  through  the  whole  six  weeks  with 
a  very  keen  appetite.  The  patient  not  only 
eats  well  and  sleeps  well,  but  also  feels  well.  He 
will  tell  you  that  he  feels  ten  years  younger,  and 
he  certainly  looks  it.  There  is  also  a  wonderful 
change  in  their  physical  activity  ;  men  of  in- 
dolent habits  become  energetic,  and  take  an 
unusual  amount  of  exercise,  a  common  expression 
being,  "  I  never  get  tired  now."  The  whole 
physical  system  is  built  up  and  strengthened.     I 


TREATMENT  265 

have  seen  long-standing,  complicating  diseases 
disappear  during  treatment,  such  as  chronic 
bronchitis,  indigestion,  constipation,  nervous- 
ness, rheumatism,  chronic  headaches,  palpita- 
tion, and  even  consumption  have  yielded  to  the 
treatment.  This  list  reads  very  much  like  that 
of  a  patent  medicine  wrapper,  but  no  doubt  the 
explanation  lies  in  the  improved  opsonic  index, 
and  the  greatly  lessened  amount  of  toxins,  while 
one  can  readily  understand  the  action  of  the  atro- 
pine and  strychnine  in  constipation  and  chest 
troubles.  The  mental  effect  is  often  remarkable. 
Different  patients  will  express  the  result  in  differ- 
ent ways.  The  statement  of  one  of  my  very 
earliest  patients  was  so  striking  that  I  have  never 
forgotten  it.  He  said  he  was  hke  a  man  from 
whose  eyes  scales  had  fallen.  He  was  a  broker, 
and  had  always  considered  himself  as  clear-headed 
as  most  men  ;  but  the  mental  clearness  which 
came  to  him  with  the  treatment  was  a  revelation 
to  him.  An  accountant  found  that  he  could  add 
columns  of  figures  with  a  rapidity  and  certainty 
to  which  he  had  been  a  stranger  for  years  ;  a 
stair  builder,  who  had  had  to  abandon  his  work 
before  treatment  on  account  of  his  frequent 
miscalculation,  found  that  he  could  plan  with  as 
much  certainty  as  ever  after  treatment.  Doctors, 
lawyers,  and   literary   men   expressed   the  same 


266  MODERN  TREATMENT  OF  ALCOHOLISM 

thing.  In  all  this  there  is  something  beyond 
the  usual  effect  observed  when  alcohol  is  with- 
drawn and  tonics  administered.  That  the 
atropine  plays  a  part  far  beyond  our  present 
knowledge  of  it  I  am  convinced,  but  what  that 
part  is  I  do  not  yet  know. 

I  am  often  asked  the  question,  "  Is  the  effect 
of  the  treatment  permanent  ?  "  The  patient 
leaves  the  sanatorium  with  no  craving  or  desire 
for  alcohol ;  this  condition  remains  permanent 
so  long  as  no  alcohol  is  taken.  It  is  therefore 
an  easy  matter  for  any  patient  to  remain  a 
teetotaller  if  he  has  any  desire  to  do  so.  He  is 
placed  in  the  same  position  as  he  was  before 
he  learned  to  drink.  It  is  my  usual  custom  to 
try  and  get  a  candid  opinion  from  the  patient 
before  he  leaves  the  home  with  regard  to  his 
desire  for  alcohol.  Some  of  the  replies  are 
characteristic — such  as,  "I  could  swim  through 
it  and  not  want  to  wet  my  lips  !  "  "I  would 
as  soon  think  of  drinking  ink  !  "  "I  would 
as  soon  think  of  taking  a  drink  of  poison."  "  An 
undertaker's  window  would  be  as  attractive  to 
me  now  as  that  of  a  wine-shop,"  or  "  The  very 
thought  of  it  makes  me  feel  nauseated."  The 
majority  of  patients  express  themselves  in  terms 
which  mean  the  same  thing.  One  may  be  excused 
for  asking  the  question,  ' '  Are  these  statements 


TREATMENT  267 

sincere  ?  "  I  have  only  to  turn  to  the  subse- 
quent hves  of  these  patients  to  know  the  truth. 
I  have  known  patients  to  suffer  the  loss  of  near 
and  dear  ones  without  resorting  to  alcohol; 
others  to  lose  all  their  money,  suffer  privation 
to  which  they  had  not  been  accustomed,  and  yet 
refuse  to  touch  alcohol.  Patients  have  refused 
to  take  it  when,  lying^seriously  ill,  and  it  was 
ordered  by  the  doctor  in  attendance,  until  I  had 
been  consulted.  Two  cases  in  particular  will 
well  illustrate  this.  One  was  that  of  a  lady  who 
had  been  treated  three  years  before  and  had 
just  undergone  an  abdominal  operation.  After 
the  operation  persistent  vomiting  set  in,  which 
had  resisted  all  efforts  to  relieve.  Those  in  charge 
of  the  patient  decided  to  try  iced  champagne, 
but  the  patient  firmly  refused  to  take  it  unless 
they  had  obtained  my  consent.  Even  then 
the  champagne  had  to  be  disguised  before  the 
patient  could  take  it.  This  was  done  by  per- 
fuming some  cotton-wool  and  stopping  up  the 
nostrils  with  it,  so  that  the  patient  should  not 
smell  the  fumes  of  the  hquor.  Another  patient 
was  a  man  who  was  dying  of  cancer,  and  had  but 
a  few  days  at  most  to  live.  Yet  he  persistently 
refused  the  little  wine  which  his  doctor  wished  to 
give  him.  I  have  had  publicans  for  patients  who 
had   to   serve   their   customers  daily   after   their 


268  MODERN  TREATMENT  OF  ALCOHOLISM 

return  home,  yet  they  refused  to  touch  alcohol 
themselves.  They  all  agreed  in  saying  that  it 
was  difficult  for  them  to  handle  the  stuff  owing 
to  the  effects  the  fumes  had  upon  them,  giving 
them  an  unpleasant  sensation  which  I  have 
before  referred  to.  I  could  quote  hundreds  of 
such  results,  but  the  above  will  illustrate  what 
takes  place. 

Let  me  summarise  the  main  advantages  of 
the  treatment.  It  usually  only  takes  six  weeks. 
The  patient  is  not  deprived  of  his  liberty  for  more 
than  two  or  three  days  at  the  most,  and  in  many 
cases  not  at  all.  The  craving  for  alcohol  is 
absolutely  destroyed.  The  craving  never  returns 
of  its  own  accord.  The  treatment  is  useless 
in  all  pure  cases  of  class  4.  It  will  cure  all 
cases  of  class  i  and  2,  and  without  it  cases  of 
class  3  cannot  be  cured.  The  time  saved  in 
treatment  must  be  a  great  consideration  to 
most  patients.  There  is  nothing  unpleasant 
to  the  patient  in  the  treatment ;  many  of  my 
patients  have  said  that  their  stay  at  the  sana- 
torium was  one  of  the  most  pleasant  experiences 
of  their  lives. 

Case  I. — E.  M.,  aged  45,  entered  for  treatment 
August  1895 ;  of  cadaverous  appearance,  slight 
physique,  markedly  nervous,  general  health  bad, 


TREATMENT  269 

suffering  greatly  from  insomnia.  He  was  a 
heavy  smoker.  The  attacks  of  alcohohsm  were 
periodical,  and  lasted  about  a  fortnight.  During 
the  two  or  three  months'  intervals  he  had  no 
desire  for  stimulants.  While  transacting  his 
ordinary  business  he  would  suddenly  be  seized 
with  an  uncontrollable  desire  for  them,  and 
rushing  from  the  room  would  disappear  for  a 
time  ;  he  would  be  found  later  in  the  back  room 
of  some  low  inn,  where  he  had  been  drinking  large 
quantities  of  whisky.  During  the  debauches 
he  would  talk  quite  rationally,  but  afterwards 
could  remember  nothing  of  what  had  occurred. 
Prior  to  the  beginning  of  treatment  the  patient 
was  found  by  his  friends,  after  having  been  in 
hiding  for  three  days,  commencing  a  fresh 
debauch. 

Finding  the  patient  hypersensitive  to  the 
effect  of  strychnine,  I  did  not  push  this  drug 
beyond  lyV^h  gr.  three  times  daily.  In  combination 
with  this  I  gave  atropine  sulphate,  commencing 
with  ^xj-'th  gr.,  and  gradually  increasing  the  doses 
until  the  eyes  and  mouth  were  affected  ;  this 
strength  was  maintained  for  a  fortnight,  and  the 
drug  withdrawn  two  days  later.  The  patient 
was  also  given  every  three  hours  a  mixture  of  red 
cinchona  bark,  gentian,  and  capsicum.  The 
above  strength  of  strychnine  was  maintained 
until  the  twenty-eighth  day,  when  it  was  gradually 
reduced  to  nil  at  the  end  of  the  fifth  week.  The 
capsicum  in  the  mixture  was  only  administered 


270  MODERN  TREATMENT  OF  ALCOHOLISM 

during  the  first  fortnight,  and  the  simpler  mixture 
continued  during  the  remainder  of  the  course. 
The  patient  lost  the  craving  for  stimulants  on 
the  third  day  ;  on  the  next  day  the  insomnia 
disappeared,  his  general  health  improved  with 
marked  rapidity,  and  he  left  the  sanatorium  at 
the  end  of  six  weeks  enjoying  excellent  health. 

In  1901,  when  I  last  heard  of  this  man,  he  was 
still  perfectly  well,  and  there  had  been  no  return 
of  his  troubles. 

Case  II. — W.  B.,  aged  45,  entered  November 
1896 ;  married.  At  the  time  of  commencing 
treatment  he  had  been  drinking  to  excess  for 
five  years.  His  nervous  system  was  completely 
shattered,  and  the  heart's  action  weakened  ; 
he  was  very  emaciated  and  anaemic. 

Treatment  was  as  follows  :  Strychnine  in- 
jections were  administered  four  times  a  day,  com- 
mencing with  gig-th  gr.,  and  sulphate  of  atropine, 
commencing  with  ^rioth  gr.  At  the  end  of  the 
second  day  the  desire  for  alcohol  had  completely 
disappeared.  On  the  morning  of  the  third  day, 
I  was,  however,  compelled  temporarily  to  with- 
draw the  atropine,  as  the  man  began  to  develop 
symptoms  of  delirium  tremens  ;  these  I  met 
with  a  hypodermic  injection  of  J  gr.  of  morphine, 
which  sent  the  patient  into  a  sound  sleep,  lasting 
ten  hours.  After  regaining  consciousness  the 
dehrium  had  quite  disappeared.  The  atropine 
injections  were  resumed  upon  the  following  day, 


TREATMENT  271 

and  continued  as  in  Case  I.  ;  the  stryclmine 
was  rapidly  increased,  so  that  by  the  fourth  day 
he  was  receiving  .^  o^l^  gi"-  ^^^ch  injection  ;  and  this 
strength  was  continued  for  twenty  days,  when 
it  was  gradually  reduced  to  nothing  at  the  end 
of  the  fourth  week.  The  rest  of  the  treatment 
varied  but  little  from  that  in  Case  L 

The  patient  was  so  satisfied  with  the  results, 
that  during  the  two  years  following  his  admission 
he  was  the  means  of  inducing  a  number  of  men 
from  his  native  town  to  undergo  treatment.  I 
may  state  that  most  satisfactory  reports  regarding 
this  patient  have  recently  come  to  hand — that  is, 
September  1903. 

Case  IIL — A.  B.,  aged  32,  married,  one  child, 
entered  for  treatment  May  1891.  He  was  anaemic, 
of  slight  build,  highly  nervous,  but  there  were 
no  signs  of  visceral  disease.  He  had  been  drinking 
to  excess  for  about  three  years. 

Entering  under  compulsion,  and  consequently 
refusing  treatment,  it  was  with  difficulty  that  I 
succeeded  in  inducing  him  to  submit  to  treatment 
by  allowing  whisky  at  frequent  intervals.  He 
was  able  to  take  this  stimulant  for  two  days, 
but  on  the  morning  of  the  third  he  could  not 
bear  its  odour,  and  although  he  made  persistent 
efforts  to  drink  a  glass  of  whisky-and-soda,  was 
quite  unable  to  do  so.  Being  an  intelligent  man, 
he  recognised  that  some  change  had  taken  place, 
and  decided  to  go  through  with  the  treatment. 


272  MODERN  TREATMENT  OF  ALCOHOLISM 

From  that  time  on  to  the  completion  of  the 
course  he  gave  me  no  trouble,  but,  on  the  con- 
trary, became  intensely  interested  in  his  progress 
towards  recovery.  The  hypodermic  treatment 
consisted  of  four  injections  daily  of  strychnine 
nitrate,  and  atropine  sulphate,  commencing  with 
Jg-  gr.  and  -^^  gr.  respectively.  In  conjunction 
with  this  he  received  every  three  hours  a  mixture 
of  red  cinchona  bark,  coca,^  gentian,  and  capsicum. 
The  strychnine  was  rapidly  increased,  so  that 
by  the  third  day  he  was  receiving  ^  gr.  each 
injection,  this  strength  being  maintained  for 
twenty-one  days,  when  it  was  gradually  reduced 
to  ?iil  at  the  end  of  the  fourth  week.  The  atro- 
pine was  slowly  increased  until  the  usual  physio- 
logical symptoms  appeared  on  the  fifth  day, 
and  this  strength  was  maintained  until  the  thir- 
teenth day,  when  it  was  gradually  reduced,  and 
finally  discontinued  on  the  sixteenth  day.  The 
coca  and  capsicum  in  the  mixture  were  only 
administered  during  the  first  fortnight,  and  the 
simpler  mixture  continued  during  the  remainder 
of  the  course,  which  lasted  altogether  five  weeks. 
During  the  whole  course  of  treatment  he  resided 
with  his  wife  at  a  neighbouring  inn.  Here 
he  had  every  facility  for  indulgence  in  his  former 
habits,  and  enj  oyed  entire  liberty  after  the  fourth 
day.     He  rapidly  gained  in  strength  and  flesh, 

^  For  some  years  now  I  have  entirely  omitted  the  use  of  coca,  and 
believe  that  it  played  no  useful  part  in  the  treatment  of  these 
earlier  cases, 


TREATMENT  273 

his  apppetite  for  food  returned  during  the  first 
week  and  remained  excellent  throughout  ;  he 
slept  well,  thoroughly  enjoyed  the  daily  exercise 
prescribed,  and  left  for  home  in  good  health. 

I  met  with  this  gentleman  about  three  months 
ago,  and  ascertained  that  ever  since  the  treatment, 
thirteen  years  ago,  he  had  retained  a  strong 
aversion  to  all  aVoholic  stimulants.  I  may  add 
that  about  seven  years  ago  he  passed  through  a 
severe  financial  crisis,  owing  to  the  worries  of 
which  he  became  very  depressed.  At  this  time 
he  was  in  a  strange  country — separated  from  all 
his  friends,  and  in  the  heart  of  a  heavy  drinking 
community.  I  naturally  asked  him  whether, 
under  this  great  trial,  he  felt  any  inclination 
to  resort  to  stimulants  ;  his  reply  was  that  he 
never  once  thought  of  them.  Prior  to  his 
treatment  his  family  physician  had  informed 
me  that  he  would  not  live  two  months  longer 
unless  something  was  done  to  check  his  heavy 
excesses. 

Case  IV. — C.  H.,  aged  50,  married,  a  commer- 
cial traveller,  was  treated  May  1891.  He  began 
drinking  at  the  age  of  twenty,  but  did  not  drink 
to  excess  till  he  was  thirty-five.  Though  a  man  of 
exceptional  ability,  his  drinking  habits  had  brought 
him  so  low  as  to  cause  him  to  sell  his  furniture 
to  obtain  money  for  drink.  He  had  been 
unusually  fleshy,  but  at  this  time  the  flesh  hung 
upon  him  loosely,  and  there  was  considerable 
18 


274  MODERN  TREATMENT  OF  ALCOHOLISM 

enlargement  and  tenderness  in  the  hepatic  region. 
The  heart's  action  was  weak,  but  there  were  no 
lesions  ;  the  mental  faculties,  even  during  sober 
periods,  were  enfeebled.  The  man  was  a  nervous 
wreck,  the  slightest  thing  throwing  him  into 
either  tears  or  excessive  laughter. 

Treatment  was  as  follows  :  Three  strychnine 
injections  were  administered  precisely  as  in  Case 
in.  The  atropine  was  commenced  in  the  same 
w^ay,  but  was  temporarily  withdrawn  after  two 
days'  administration,  as  symptoms  of  delirium 
tremens  appeared.  Doses  of  whisky  had  been 
allowed  periodically  up  to  this  time,  and  to 
obtain  sleep  30  grs.  of  potassium  bromide  had  been 
added  to  the  final  drink  of  the  day.  Although 
he  slept  off  and  on  during  the  second  night,  the 
delirious  symptoms  remained.  On  the  morning 
of  the  third  day  he  was  given  |  gr.  of  morphine 
hypodermically  ;  at  the  end  of  two  hours  the 
excitement  had  increased  to  such  an  extent 
that  he  was  rapidly  exhausting  his  remaining 
strength.  Another  ^  gr.  was  injected,  and  after 
an  hour  and  a  half  had  passed  without  the  desired 
result  another  J  gr.  was  administered.  This 
caused  the  excitement  to  subside  in  about  ten 
minutes,  so  that  he  dropped  into  a  deep  sleep 
which  lasted  for  about  seven  hours.  Upon 
waking  for  a  few  minutes  he  took  some  bovril, 
and  I  gave  an  injection  of  strychnine.  Another 
quiet  sleep  ensued  for  about  the  same  period  as 
the  first.     During  the  few  minutes  he  was  next 


TREATMENT  275 

awake  he  was  fed  and  treated  as  before  ;  alto- 
gether he  slept  for  twenty-four  hours,  at  the  end 
of  which  time  the  atropine  injections  were  re- 
sumed and  continued  as  in  Case  IIL  He  found 
on  regaining  consciousness  that  the  craving  for 
stimulants  was  greatly  lessened,  and  during  the 
course  of  the  next  two  days  it  not  only  disappeared, 
but  was  replaced  by  absolute  aversion  to  alcohol. 
With  the  exception  of  some  slight  modifications 
incidental  to  the  condition  of  the  patient's 
system,  the  treatment  varied  but  little  from  that 
in  Case  III.  during  the  remainder  of  the  course. 
He  returned  home  in  what  he  was  pleased  to 
term  "  the  pink  of  condition,"  his  treatment 
having  lasted  five  weeks. 

During  the  second  week  he  informed  me  that 
he  had  apparently  been  "  living  in  a  cloud," 
but  he  now  felt  as  though  "  scales  had  fallen  " 
from  his  eyes,  and  that  he  could  not  only  think 
and  see  clearly,  but  that  also  his  views  on  the  use 
of  intoxicants  had  been  entirely  reversed.  His 
subsequent  career  proved  that  his  recovery 
was  complete.  It  may  be  added  that  three  years 
after  treatment  he  unintentionally  took  some 
brandy  sauce  when  away  from  home  ;  the 
effect  was  remarkable,  in  that  he  had  hardly  time 
to  leave  the  dining-room  before  vomiting.  He 
remained  well  in  January  1904. 

The  four  cases  cited  are  typical  of  the  majority, 
but  I  may  refer  to  one  extreme  case  that  passed 
through   my  hands  in  October    1895.     It  was  a 


276  MODERN  TREATMENT  OF  ALCOHOLISM 

case  of  acute  alcoholic  poisoning  m  a  man  thirty 
years  of  age.  He  was  a  confirmed  inebriate, 
and  not  expected  to  rally  from  the  unconscious 
condition  in  which  I  found  him.  I  agreed  to 
treat  him  in  consultation  with  his  medical  adviser, 
provided  consciousness  was  regained.  The 
treatment  was  administered  at  his  own  home  ; 
and  as  the  man  had  no  idea  that  he  was  being 
treated  for  alcohohsm,  I  purposely  left  the 
decanter  and  siphon  within  his  reach.  On  the 
fifth  day  he  ordered  them  out  of  his  sight,  re- 
marking that  their  presence  nauseated  him. 
This  may  be  scarcely  credible,  but  I  can  vouch 
for  the  accuracy  of  the  statement.  It  was 
not  until  his  recovery  was  completed  that  he 
was  informed  of  the  reason  of  his  treatment. 
When  I  last  heard  of  the  patient  three  years 
ago,  there  had  been  no  relapse  to  his  former 
habits. 

I  think  that  the  foregoing  cases  will  fully 
illustrate  the  method  of  application. 

We  now  have  to  consider  the  treatment  of  the 
Morphine  habit.  There  are  three  distinct  classes  of 
treatment,  namely,  that  which  favours  immediate 
withdrawal  of  the  drug,  that  which  favours  a 
very  gradual  reduction,  and  that  which  favours 
the  middle  course,  i.e.  semi-rapid  withdrawal. 
Personally,  I  do  not  think  that  an  exclusive 
resort  to  any  one  of  these  methods  is  justified, 


TREATMENT  277 

for  it  is  purely  a  question  of  the  nature  of  the 
case  itself.  Dilierent  patients  require  different 
treatment  ;  no  single  method  is  suitable  to 
every  case.  Each  method  has  its  particular 
field  of  usefulness.  If  the  habit  is  of  recent 
acquisition  and  the  quantity  of  the  drug  taken  is 
small  and  the  constitution  strong,  an  abrupt 
withdrawal  of  the  drug  is  the  best  and  quickest 
method.  On  the  other  hand,  there  are  cases 
where  the  amount  of  the  drug  taken  is  very 
large,  the  habit  of  long  duration,  and  the  general 
health  broken  ;  here  it  would  be  very  unwise  to 
withdraw  the  drug  abruptly.  Between  these 
two  classes  of  patients  there  are  a  large  number 
of  patients  who  are  neither  so  broken  in  health 
nor  such  heavy  users  of  the  drug,  and  these  form 
a  very  suitable  class  for  semi-rapid  withdrawal. 
We  ought  therefore  to  consider  the  nature  of  the 
case  before  deciding  upon  the  form  of  treat- 
ment. If  we  are  wise,  we  will  also  remember  the 
peculiar  action  of  the  drug,  in  even  minute  doses, 
upon  habitual  users  during  withdrawal,  namely, 
the  shock  which  will  be  experienced  by  the 
patient  at  the  end,  no  matter  how  small  the  dose 
suddenly  withdrawn.  In  this  fact  lies  the 
strongest  argument  against  the  prolonged  with- 
drawal in  all  save  the  very  feeble.  The  most 
generally     adopted     plan     is     the     semi -rapid 


278  MODERN  TREATMENT  OF  ALCOHOLISM 

withdrawal  ;     I     will     therefore     describe     this 
first. 

Having  decided  that  the  patient  is  one  suitable 
for  this  method  of  treatment,  we  proceed  to  dis- 
possess him  of  all  supphes  of  the  drug,  syringes, 
etc.  Having  made  the  usual  routine  examina- 
tion with  regard  to  his  health,  we  proceed  to  treat 
him.  He  will  always  tell  you  the  amount  he 
requires  daily,  and  I  invariably  begin  treatment 
by  administering  half  this  quantity.  I  do  not 
ever  remember  a  case  in  which  this  amount  did 
not  satisfy  the  patient,  provided  he  understood 
that  he  was  getting  what  he  had  asked  for.  The 
particular  method  of  reduction  is  immaterial, 
provided  it  is  regular  and  steadily  adhered  to 
when  once  begun.  Some  place  a  certain  amount 
of  the  drug  in  solution  in  a  bottle,  and  as  the 
injection  is  withdrawn  the  bottle,  is  filled  up  with 
distilled  water,  so  that  each  succeeding  injection 
is  weaker  than  the  preceding  one.  The  objection 
to  this  treatment  is  the  amount  of  calculation 
required  to  adapt  the  size  of  the  bottle,  daily 
dose,  etc.,  the  lack  of  elasticity  to  meet  unfore- 
seen complications,  and  the  difficulty  of  keeping 
the  solution  sterile  over  the  length  of  time  with- 
out disturbing  the  accuracy  of  the  dosage.  A 
better  plan  to  my  mind  is  to  have  the  solution 
made  up  for  a  few  days  of  the  required  strength, 


TREATMENT  279 

and  record  actual  dose  administered  daily.  By 
giving  the  injections  at  regular  hours  one  has 
only  to  arrange  the  sheet  so  that  these  hours 
will  appear  opposite  each  day  of  the  treatment. 
The  advantages  of  this  method  are  accurate 
dosage,  absolute  sterility  of  solution,  elasticity, 
and  a  complete  record  of  the  case.  If  a  space  is 
left  for  remarks,  the  cause  for  each  variation  of 
dosage  is  apparent  at  a  glance.  Injections  of 
strychnine  nitrate  and  atropine  sulphate  are 
administered  throughout  the  time  the  patient  is 
taking  the  drug.  Then  the  atropine  is  with- 
drawn. The  same  mixture  as  used  in  the  treat- 
ment of  alcoholism  is  administered  daily  during 
the  course.  To  relieve  the  pain  and  discomfort, 
nothing  answers  so  well  as  dry  heat  combined 
with  phenacetin  and  caffeine.  Warm  baths  are 
useful,  but  must  be  used  with  caution  ;  a  patient 
should  never  be  allowed  to  take  one  without  an 
attendant  being  present  throughout  the  whole 
time  of  the  bath.  If  the  insomnia  is  marked, 
veronal  sodium  is  probably  the  best  drug  to  use  ; 
but  it  must  always  be  remembered  that  it  is  only  a 
substitute  for  the  morphine,  and  should  only  be 
used  in  extreme  conditions  of  insomnia.  Proper 
diet  is  also  important,  every  effort  being  made  to 
nourish  the  patient  rapidly.  It  will  be  found 
that  the  drug  may  be  cut  down  to  2  grs.  per  day 


28o  MODERN  TREATMENT  OF  ALCOHOLISM 

rapidly  without  much  discomfort,  and  it  is  after 
this  that  the  real  fight  begins.  Many  patients 
will  tell  you  that  they  have  succeeded  in  cutting 
the  amount  down  to  this  extent  themselves  by 
an  exercise  of  the  will-power,  but  few  ever  get 
below  this  amount  without  help.  If  we  continue 
halving  the  dose  daily,  or  every  second  day,  we 
will  soon  reach  a  point  where  the  amount  is 
ridiculously  small  in  comparison  to  that  used  with 
non-habit  patients  ;  yet  the  victim  will  look  for 
that  dose  as  eagerly  as  he  formerly  did  for  the 
30  or  40  grs.  he  was  accustomed  to  take  daily. 
I  have  seen  a  patient  miss  such  a  small  dose  as 
eVth  grain  in  the  twenty-four  hours,  when  at  one 
time  he  was  used  to  the  heavier  doses  mentioned 
above.  The  usual  test  satisfied  me  that  this  was 
not  mere  fancy  on  his  part. 

The  method  of  slow  withdrawal  is  not  important 
in  itself,  and  should  never  be  used  except  in  the 
very  few  cases  where  the  health  of  the  patient  is 
so  bad  that  no  other  method  can  be  used.  The 
principle  of  the  treatment  is  to  keep  the  growth  of 
the  habit  in  check  until  the  patient's  general  health 
has  improved  sufficiently  to  allow  of  reduction, 
which  is  then  carried  out  in  a  very  gradual  manner. 

The  abrupt  withdrawal  of  the  drug.  Where 
this  method  can  be  safely  used  it  is  the 
most  satisfactory  of  all.     It  is  short,  sharp,  and 


TREATMENT  281 

decisive.  Six  weeks  is  ample  in  which  to  cure 
most  patients.  I  have  cured  a  patient  taking 
70  grs.  a  day  in  four  weeks,  and  that  without 
pain  or  discomfort  or  any  restriction  of  his  hberty. 
I  would  not  administer  the  treatment  to  one  who 
was  not  in  a  fair  condition  physically,  but,  given 
this  condition,  I  believe  this  method  to  be  as  safe 
as  any  other  ;  certainly  to  be  preferred  in  every 
other  respect.  The  patient  is  first  prepared  with 
the  usual  purgative  dose  ;  then  the  strychnine, 
nitrate,  and  atropine  sulphate  treatment  is  pushed 
rapidly,  so  that  the  strychnine  nitrate  is  given  in 
^Vth  grain  doses  three  times  a  day  at  the  end  of  the 
third  day,  while  the  atropine  sulphate  is  increased 
until  marked  delirium  is  obtained.  It  will  now 
be  found  that  the  patient  will  not  ask  for  or 
apparently  expect  any  morphia.  The  dose  of 
the  atropine  sulphate  must  then  be  reduced  till 
only  enough  is  given  to  maintain  a  mild  condition 
of  delirium,  and  the  usual  tonic  mixture  men- 
tioned before  is  administered  throughout  the 
treatment.  During  the  delirium,  which  is  allowed 
to  continue  for  four  or  five  days,  the  patient  is 
generally  free  from  excitement,  being  content  to 
sit  still  most  of  the  time.  His  delusions  are  of  a 
harmless  character.  No  morphia  is  given,  the 
patient  being  as  indifferent  to  it  as  one  who  had 
never    used    it.     He    eats    and    sleeps   normally 


282  MODERN  TREATMENT  OF  ALCOHOLISM 

during  this  period,  and  when  not  mentioning  his 
delusions  he  talks  quite  rationally,  but  never 
refers  to  the  question  of  morphine.  At  the  end 
of  the  first  week  all  excess  of  sulphate  of  atropine 
is  withdrawn,  and  when  he  has  become  quite 
normal  mentally  it  will  be  found  that  he  has  no 
desire  for  the  drug.  The  strychnine  nitrate 
injections  are  given  throughout  the  entire  course, 
but  the  atropine  sulphate  is  given  in  ordinary 
doses  for  only  two  weeks  longer,  when  it  is  with- 
drawn entirely. 

Complications  must  be  met,  as  in  all  other  cases, 
with  the  proper  treatment. 

The  treatment  of  such  drug  habits  as  the 
Cocaine  habit.  Paraldehyde,  Chloral,  Sulphonal, 
Trional,  and  Veronal  habits,  is  similar  to  that  for 
morphine.  Of  these  the  Cocaine  and  Chloral 
habits  are  well  known,  but  cases  of  the  others  are 
much  rarer.  I  have  treated  patients  of  each 
kind.  The  symptoms  vary  with  the  particular 
drug  used,  but  there  is  a  great  similarity  in  the 
main.  There  is  intense  craving  for  the  particular 
drug  used  when  the  patient  cannot  obtain  it.  If 
the}^  have  to  wait  too  long  for  it  they  are  likely 
to  become  delirious  ;  when  this  stage  is  reached, 
there  is  nothing  to  indicate  the  particular  drug 
used.  In  each  case  treated  by  myself,  the  patient 
was  either  a  doctor  or  a  chemist,  chiefly  the  latter. 


ALCOHOLIC  TRANCE  283 

The  reduction  of  the  drug  in  these  cases  is  much 
less  difficult  than  in  a  morphia  patient,  and  the 
suffering  decidedly  less  marked. 

Alcoholic  Trance 

I  have  already  given  my  own  experiences  of 
this  peculiar  phase  of  alcoholism,  but  the  following 
from  the  Journal  of  the  American  Association 
of  Inebriety  is  interesting  : — 

Some  Forms  of  Irresponsibility — Alcoholic 
Trance 

The  frequent  statement  of  prisoners  in  court, 
that  they  did  not  remember  anything  about  the 
crime  they  are  accused  of,  appears  from  scientific 
study  to  be  a  psychological  fact.  How  far  this 
is  true  in  all  cases  has  not  been  determined,  but 
there  can  be  no  question  that  crime  is  often 
committed  without  a  conscious  knowledge  or 
memory  of  the  act  at  the  time. 

It  is  well  known  to  students  of  mental  science, 
that  in  certain  unknown  brain  states  memory 
is  palsied,  and  fails  to  note  the  events  of  life 
and  surroundings.  Like  the  somnambulist,  the 
person  may  seem  to  realise  his  surroundings 
and  be  conscious  of  his  acts,  and  later  be  unable 
to  recall  anything  which  has  happened.  These 
blanks    of   memor}/    occur    in    many    disordered 


284  MODERN  TREATMENT  OF  ALCOHOLISM 

states  of  the  brain  and  body,  but  are  usually  of 
such  short  duration  as  not  to  attract  attention. 
Sometimes  events  that  occur  in  this  state  may 
be  recalled  afterwards,  but  usually  they  are  total 
blanks.  The  most  marked  blanks  of  memory 
have  been  noted  in  cases  of  epilepsy  and  inebriety. 
When  they  occur  in  the  latter  they  are  called 
Alcoholic  Trances,  and  are  always  associated 
with  excessive  use  of  spirits. 

Such  cases  are  noted  in  persons  who  use  spirits 
continuously,  and  who  go  about  acting  and  talking 
sanely  although  giving  some  evidence  of  brain 
failure,  yet  seem  to  realise  their  condition  and 
surroundings.  Some  time  after,  they  wake  up 
and  deny  all  recollection  of  acts  or  events  for  a 
certain  period  in  the  past.  This  period  to  them 
begins  at  a  certain  point  and  ends  hours  or  days 
after,  the  interval  of  which  is  a  total  blank,  like 
that  of  unconscious  sleep.  Memory  and  certain 
brain  functions  are  suspended  at  this  time, 
while  the  other  brain  activities  go  on  as  usual. 

In  all  probability  the  continued  paralysis  from 
alcohol  not  only  lowers  the  nutrition  and  func- 
tional activities  of  the  brain,  but  produces  a 
local  palsy,  followed  by  a  temporary  failure  of 
consciousness  and  memory,  which  after  a  time 
passes  away. 

When  a  criminal  claims  to  have  had  no  memory 
or  recollection  of  the  crime  for  which  he  is  accused, 
if  his  statement  is  true,  one  or  two  conditions 
is  probably  present,  either  epilepsy  or  alcoholism. 


ALCOHOLIC  TRANCE  285 

Such  a  trance  state  might  exist  and  the  person 
be  free  from  epilepsy  and  alcohohsm,  but  from  our 
present  knowledge  of  this  condition  it  would 
be  difficult  to  determine  this  fact.  If  epilepsy 
can  be  traced  in  the  history  of  the  case,  the 
trance  state  has  a  pathological  basis  for  its 
presence.  If  the  prisoner  is  an  inebriate,  the 
same  favouring  conditions  are  present.  If  the 
prisoner  has  been  insane,  and  suffered  from  sun 
or  heat  stroke,  and  the  use  of  spirits  are  the 
symptoms  of  brain  degeneration,  the  trance  state 
may  occur  any  time. 

The  fact  of  the  actual  existence  of  the  trance 
state  is  a  matter  for  study,  to  be  determined 
from  a  history  of  the  person  and  his  conduct  ; 
a  grouping  of  evidence  that  the  person  cannot 
simulate  or  falsify  ;  evidence  that  turns  not 
on  any  one  fact,  but  on  an  assemblage  of  facts 
that  point  to  the  same  conclusion. 

The  following  cases  are  given  to  illustrate  some 
of  these  facts,  which  support  the  assertion  of  no 
memory  of  the  act  by  the  prisoner  in  court  : 

The  first  case  is  that  of  A.,  who  was  repeatedly 
arrested  for  horse  stealing,  and  always  claimed 
to  be  unconscious  of  the  act.  This  defence  was 
regarded  with  ridicule  by  the  court  and  jury, 
and  more  severe  sentences  were  imposed,  until, 
finally,  he  died  in  prison.  The  evidence  offered 
in  different  trials  in  defence  was,  that  his  father 
was  weak-minded  and  died  of  consumption, 
and  his  mother  was  insane  for  many  years,  and 


286  MODERN  TREATMENT  OF  ALCOHOLISM 

died  in  an  asylum.  His  early  life  was  one  of 
hardship,  irregular  living,  and  no  training.  At 
sixteen  he  entered  the  army,  and  suffered  from 
exposure,  disease,  and  sunstroke,  and  began  to 
drink  spirits  to  excess  at  this  time.  At  twenty 
he  was  employed  as  a  hack-driver,  and  ten  years 
later  became  owner  of  a  livery  stable.  He  drank 
to  excess  at  intervals,  yet  during  this  time  attended 
to  business,  acting  sanely  and  apparently  conscious 
of  all  his  acts,  but  often  complained  he  could 
not  recollect  what  he  had  done  while  drinking. 
When  about  thirty-four  years  of  age,  he  would, 
while  drinking,  drive  strange  horses  to  his  stable, 
and  claim  that  he  had  bought  them.  The  next 
day  he  had  no  recollection  of  these  events,  and 
made  efforts  to  find  the  owners  of  these  horses 
and  return  them.  It  appeared  that  while  under 
the  influence  of  spirits  the  sight  of  a  good  horse 
hitched  up  by  the  roadside  alone,  created  an 
intense  desire  to  possess  and  drive  it.  If  driving 
his  own  horse,  he  would  stop  and  place  it  in  a 
stable,  then  go  and  take  the  new  horse,  and  after 
a  short  drive  put  it  up  in  his  own  stable,  then  go 
and  get  his  own  horse. 

The  next  day  all  this  would  be  a  blank,  which 
he  could  never  recall.  On  several  occasions  he 
displayed  reasoning  cunning,  in  not  taking  a 
horse  when  the  owners  or  drivers  were  in  sight. 
This  desire  to  possess  the  horse  seemed  under 
control,  but  when  no  one  was  in  sight  all  caution 
left   him,    and   he    displayed   great   boldness   in 


ALCOHOLIC  TRANCE  287 

driving  about  in  the  most  public  way.  If  the 
owner  should  appear  and  demand  his  property, 
he  would  give  it  up  in  a  confused,  abstract  way. 
No  scolding  or  severe  language  made  any  im- 
pression on  him.  Often,  if  the  horse  seemed 
weary,  he  would  place  it  in  the  nearest  stable, 
with  strict  orders  to  give  it  special  care.  On  one 
occasion  he  joined  in  a  search  of  a  stolen  horse, 
and  found  it  in  a  stable  where  he  had  placed  it 
many  days  before.  Of  this  he  had  no  recollection. 
In  another  instance  he  sold  a  horse  which  he  had 
taken,  but  did  not  take  any  money,  making  a 
condition  that  the  buyer  should  return  the  horse 
if  he  did  not  like  it.  His  horse  stealing  was  all 
of  this  general  character.  No  motive  was 
apparent,  or  effort  at  concealment,  and  on  re- 
covering from  his  alcoholic  excess  he  made  every 
effort  to  restore  the  property,  expressing  great 
regrets  and  paying  freely  for  all  losses.  The 
facts  of  these  events  fully  sustained  his  assertion 
of  unconsciousness,  yet  his  apparent  sanity  was 
made  the  standard  of  his  mental  condition. 
The  facts  of  his  heredity,  drinking,  crime,  and 
conduct  all  sustained  his  assertion  of  unconscious- 
ness of  these  events.  This  was  an  alcoholic 
trance  state,  with  kleptomaniac  impulses. 

The  next  case,  that  of  B.,  was  executed  for  the 
murder  of  his  wife.  He  asserted  positively  that 
he  had  no  memory  or  consciousness  of  the  act, 
or  any  event  before  or  after.  The  evidence 
indicated  that  he  was  an  inebriate  of  ten  years' 


288  MODERN  TREATMENT  OF  ALCOHOLISM 

duration,   dating   from   a  sunstroke.     He   drank 

periodically,  for  a  week  or  ten  days  at  a  time, 

and  during   this  period  was  intensely  excitable 

and  active.     He  seemed  always  sane  and  conscious 

of  his  acts  and  surroundings,  although  intensely 

suspicious,  exacting,  and  very  irritable  to  all  his 

associates.     When  sober  he  was  kind,  generous, 

and  confiding,  and  never  angry  or  irritable.     He 

denied  all  memory  of  his  acts  during  this  period. 

While  his  temper,  emotions,  and  conduct  were 

greatly   changed  during   this   time,   his  intellect 

seemed  more  acute  and  sensitive  to  all  his  acts 

and  surroundings.     His  business  was  conducted 

with  usual  skill,  but  he  seemed  unable  to  carry 

out   any   oral  promises,   claiming  he   could   not 

recollect  them.     His  business  associates  always 

put  all  bargains  and  agreements  in  writing  when 

he  was  drinking,  for  the  reason  he  denied  them 

when   sober.     But  when  not   drinking  his  word 

and   promise    was   always   literally   carried    out. 

He  broke  up  the  furniture  of  his  parlour  when 

in  this  state,  and  injured  a  trusted  friend,  and 

in  many  ways  showed  violence  from  no  cause  or 

reason,  and  afterwards  claimed  no  memory  of  it. 

After   these   attacks  were   over,   he   expressed 

great  alarm,  and  sought  in  every  way  to  repair 

the  injury.     Finally,  he  struck  his  wufe  with   a 

chair  and  killed  her,  and  awoke  the  next  day  in 

jail,  and  manifested  the  most  profound  sorrow. 

While  he  disclaimed  all  knowledge  of  the  crime, 

he  was  anxious  to  die  and  welcomed  his  execution. 


ALCOHOLIC  TRANCE  289 

This  case  was  a  periodical  inebriate  with  maniacal 
and  homicidal  tendencies.  His  changed  conduct 
and  unreasoning,  motiveless  acts  pointed  to  a 
condition  of  trance.  His  assertion  of  no  memory 
was  sustained  by  his  conduct  after,  and  efforts 
to  find  out  what  he  had  done  and  repair  the 
injury. 

The  third  case,  that  of  C,  was  a  man  of  wealth 
and  character,  who  forged  a  large  note,  drew  the 
money,  and  went  to  a  distant  city  on  a  visit.  He 
was  tried  and  sentenced  to  State  prison.  The 
defence  was  no  memory  or  consciousness  of  the 
act,  by  reason  of  excessive  use  of  alcohol.  This 
was  treated  with  ridicule.  Although  he  had 
drunk  to  excess  at  the  time  and  before  the  crime, 
he  seemed  rational,  and  acted  in  no  way  as  if  he 
did  not  understand  what  he  was  doing.  Both 
his  parents  were  neurotics,  and  he  began  to  drink 
in  early  life,  and  for  years  was  a  moderate  drinker. 
He  was  a  successful  manufacturer,  and  only 
drunk  to  excess  at  times  for  the  past  five  years. 
He  complained  of  no  memory  during  these  drink 
paroxysms,  and  questioned  business  transactions 
and  bargains  he  made  at  this  time.  On  one  occa- 
sion he  went  to  New  York  and  made  foolish 
purchases  which  he  could  not  recall.  On  several 
occasions  he  discharged  valuable  workmen,  and 
when  he  became  sober  took  them  back,  unable 
to  account  for  such  acts. 

These  and  other  very  strange  acts  continued  to 
increase  with  every  drink  excess.  At  such  times 
19 


290  MODERN  TREATMENT  OF  ALCOHOLISM 

he  was  reticent,  and  seemed  to  be  sensible  and 
conscious,  and  did  these  strange  acts  in  a  sudden, 
impulsive  way.  The  forged  note  was  offered 
boldly,  and  no  effort  was  made  to  conceal  his 
presence  or  destination.  When  arrested  he 
was  alarmed,  and  could  not  believe  that  he  had 
done  so  foolish  an  act.  This  was  a  clear  case  of 
alcoholic  trance,  in  which  all  the  facts  sustained 
his  assertion  of  no  conscious  memory  of  the  crime. 
In  these  three  cases  the  correctness  of  the  prisoner's 
assertions  of  no  memory  was  verified  by  all  the 
facts  and  circumstances  of  the  crime.  The  mere 
statement  of  a  person  accused  of  crime,  that  he 
had  no  memory  of  the  act,  should  lead  to  a  careful 
examination,  and  be  only  accepted  as  a  fact  when 
it  is  supported  by  other  evidence. 

The  following  case  illustrates  the  difficulty  of 
supporting  a  prisoner's  statement  of  no  m^emory 
when  it  is  used  for  purposes  of  deception  : 

Case  E.  An  inebriate  killed  a  man  in  a  fight, 
and  was  sentenced  to  prison  for  life.  He  claimed 
no  memory  or  recollection  of  the  act.  I  found 
that  when  drinking  he  seemed  conscious  of  all 
his  surroundings,  and  was  always  anxious  to 
conceal  his  real  condition ;  and  if  anything  had 
happened  while  in  this  state,  he  was  very  active 
to  repair  and  hush  it  up.  He  was  at  times  quite 
delirious  when  under  the  influence  of  spirits, 
but  would  stop  at  once  if  any  one  came  along 
that  he  respected.  He  would,  after  acting  wildly, 
seem  to  grow  sober  at  once,  and  do  everything 


ALCOHOLIC  TRANCE  291 

to  restore  the  disorder  he  had  created.  The  crime 
was  an  accident,  and  at  once  he  attempted  con- 
cealment, ran  away,  changed  his  clothing,  and 
tried  to  disguise  his  identity  ;  when  arrested, 
claimed  no  memory  or  consciousness  of  the 
act.  This  claim  was  clearly  not  true,  and  contra- 
dicted by  the  facts. 

In  a  recent  case,  F.  shot  his  partner  in  business 
while  both  were  intoxicated,  and  displayed  great 
cunning  to  conceal  the  crime  and  person  ;  then, 
after  elaborate  preparations,  went  away.  He 
made  the  same  claim  of  defence,  which  was  un- 
supported by  any  other  evidence  or  facts  in  his 
previous  life.  He  was  executed.  Of  course  it  is 
possible  for  the  trance  state  to  come  on  suddenly 
and  crime  be  committed  at  this  time ;  still,  so 
far  all  the  cases  studied  show  that  this  condition 
existed  before,  and  was  the  product  of  a  growth 
beginning  in  brief  blanks  of  a  few  moments  and 
extending  to  hours'  and  days'  duration.  Unless 
the  facts  indicated  the  trance  state  before  the 
crime  was  committed,  it  would  be  difficult  to 
establish  this  condition  for  the  first  time,  followed 
and  associated  with  the  crime. 

I  think  in  most  of  these  cases,  where  this  defence 
is  set  up,  there  will  be  found  certain  groups  of 
cases  that  have  common  physical  conditions 
of  degeneration.  These  groups  of  cases  I  have 
divided  from  a  clinical  standpoint,  the  value  of 
which  will  be  more  as  an  outline  for  future  studies. 

Probably  the  largest  number  of  criminal   in- 


292  MODERN  TREATMENT  OF  ALCOHOLISM 

ebriates  who  claim  loss  of  memory  as  a  defence  for 
their  acts,  are  the  alcoholic  dements.  This  class 
arc  the  chronic  inebriates  of  long  duration ; 
persons  who  have  naturally  physical  and  mental 
defects,  and  who  have  used  spirits  to  excess  for 
years.  This,  with  bad  training  in  early  life, 
bad  surroundings,  and  bad  nutrition,  have  made 
them  of  necessity  unsound,  and  liable  to  have 
many  and  complex  brain  defects.  Such  persons 
are  alwa^^s  more  or  less  without  consciousness 
or  realisation  of  their  acts.  They  act  auto- 
maticall}^  only,  governed  by  the  low^est  and  most 
transient  impulses.  Crimes  of  all  kinds  are 
generally  accidents  growing  out  of  the  surround- 
ings, without  premeditation  or  plan.  They 
are  incapable  of  sane  reasoning  or  appreciation 
of  the  results  of  their  conduct.  The  crime  is  un- 
reasoning, and  general  indifference  marks  all 
their  acts  afterwards.  The  crime  is  always  along 
lines  of  previous  conduct,  and  never  strange 
or  unusual.  The  claim  of  no  memory  in  such 
cases  has  always  a  reasonable  basis  of  truth  in 
the  physical  conditions  of  the  person.  Mania  is 
very  rarely  present,  but  delusions  and  morbid 
impulses  of  a  melancholic  type  always  exist. 
The  mind,  like  the  body,  is  exhausted,  depressed, 
and  acts  along  lines  of  least  resistance. 

The  second  group  of  criminals  who  claim  no 
memory  are  those  where  the  crime  is  unusual, 
extraordinary,  and  unforeseen.  Persons  who 
are   inebriates   suddenly   commit   nmrder,    steal, 


ALCOHOLIC  TRANCE  293 

or  do  some  criminal  act  that  is  foreign  to  all 
previous  conduct.  In  such  cases  the  trance 
condition  may  have  been  present  for  some  time 
before  and  escaped  any  special  notice,  except  the 
mere  statement  of  the  person  that  he  could  not 
recollect  his  acts.  The  unusual  nature  of  the 
crime,  committed  by  persons  who  never  before 
by  act  or  thought  gave  any  indication  of  it,  is 
always  a  factor  sustaining  the  claim  of  no  memory. 
The  explosive,  unreasoning  character  of  crime 
always  points  to  mental  unsoundness  and  in- 
capacity of  control. 

A  third  group  of  criminals  urge  this  statement 
of  no  memory,  who,  unlike  the  first  group,  are 
not  imbeciles,  generally.  They  are  positive 
inebriates,  drinking  to  excess,  but  not  to  stupor, 
who  suddenly  commit  crime  with  the  most 
idiotic  coolness  and  indifference,  never  manifest- 
ing the  slightest  appreciation  of  the  act  as  wrong, 
or  likely  to  be  followed  by  punishment.  Crime 
committed  by  this  class  is  never  concealed,  and  the 
criminal's  after  conduct  and  appearance  gives 
no  intimation  that  he  is  aware  of  what  he  has 
done.  These  cases  have  been  termed  moral 
paralytics,  and  the  claim  of  the  trance  state 
may  be  very  likely  true. 

A  fourth  group  of  cases,  where  memory  is 
claimed  to  be  absent,  occurs  in  dipsomaniacs 
and  periodical  inebriates,  who  have  distinct  free 
intervals  of  sobriet}^  This  class  begin  to  drink 
to  great   excess  at  once,   then  drink  less  for  a 


294  MODERN  TREATMENT  OF  ALCOHOLISM 

day  or  more,  and  begin  as  violently  as  ever 
again.  In  this  short  interval  of  moderate  drink- 
ing some  crime  is  committed  which  they  claim 
not  to  have  any  recollection  of. 

Other  cases  have  been  noted  where  a  condition 
of  mental  irritation  or  depression  preceded  the 
drink  explosion,  and  the  crime  was  committed 
during  this  premonitory  period  and  before  they 
drank  to  excess.  The  strong  probability  of  trance 
at  this  period  is  sustained  by  the  epileptic 
character  of  such  conduct  afterwards.  The 
trance  may  be  justly  termed  a  species  of  aura, 
or  brain  paralysis,  which  precedes  the  explosion. 

In  some  instances,  before  the  drink  storm 
comes  on,  the  person's  mind  would  be  filled  with 
the  most  intense  suspicions,  fears,  delusions,  and 
exhibit  a  degree  of  irritation  and  perturbation 
unusual  and  unaccountable.  Intense  excite- 
ment for  depression,  from  no  apparent  cause, 
prevails,  and  during  this  period  some  crime 
may  be  committed ;  then  comes  the  drink 
paroxysm,  and  later  all  the  past  is  a  blank. 
Trance  is  very  likely  to  be  present  at  this  time. 

In  these  groups  the  crime  is  generally  auto- 
matic, or  committed  in  a  manner  different  from 
other  similar  crimes.  Some  governing  centre 
has  suspended,  and  all  sorts  of  impulses  may 
merge  into  acts  any  moment.  The  consciousness 
of  acts  and  their  consequences  are  broken  up. 
The  strong  probability  is  that  these  trance  blanks 
begin  in  short  periods  of  unconsciousness,  which 


ALCOHOLIC  TRANCE  295 

lengthen  with  the  degeneration  and  mental 
feebleness  of  the  person.  The  obscurity  of  these 
conditions,  and  the  incapacity  of  the  victims  to 
realise  their  import,  also  the  absence  of  any 
special  study,  greatly  increases  the  difficulty. 
It  will  be  evident  from  inquiry  that  trance  states 
among  inebriates  are  common,  but  seldom  attract 
attention,  unless  they  come  into  legal  notice. 

The  practical  question  to  be  determined  in  a 
given  case  in  court  is  the  actual  mental  condition 
of  the  prisoner,  who  claims  to  have  no  recollection 
of  the  crime.  This  is  a  class  of  evidence  that 
must  be  determined  by  circumstantial  and 
collateral  facts,  which  require  scientific  expert- 
ness  to  gather  and  group.  The  Court  can  decide 
from  the  general  facts  of  the  crime  and  the 
prisoner  whether  his  claim  of  no  memory  may 
possibly  be  true,  and  order  an  expert  examination 
to  ascertain  the  facts.  This  should  be  done  in 
all  cases  where  the  prisoner  is  without  means, 
in  the  same  way  that  a  lunacy  commission  is 
appointed  to  decide  upon  insanity.  The  result 
of  this  expert  study  may  show  a  large  prepon- 
derance of  evidence  sustaining  the  claim  of  no 
memory,  or  the  opposite.  If  the  former,  the 
measure  of  the  responsibility  must  be  modified, 
and  the  degree  of  punishment  changed.  While 
such  cases  are  practically  insane  at  the  time, 
and  incapable  of  realising  or  controlling  their 
acts,  they  should  be  kept  under  legal  and  medical 
surveillance   for   a  lifetime,    if   necessary.     Such 


296  MODERN  TREATMENT  OF  ALCOHOLISM 

men  are  dangerous,  and  should  be  carefully 
watched  and  deprived  of  their  liberty  for  a  length 
of  time,  depending  on  recovery  and  capacity  to 
act  rationally  and  normally.  They  are  danger- 
ous diseased  men,  and,  like  victims  of  contagious 
disease,  must  be  housed  and  treated. 

The  future  of  such  cases  depends  on  the 
removal  of  the  causes  which  made  them  what 
they  are.  The  possibility  of  permanent  restora- 
tion is  very  promising  in  most  cases.  How  far 
alcoholic  trance  exists  in  criminal  cases  is  un- 
known, but  the  time  has  come  when  such  a  claim 
by  criminals  cannot  be  ignored,  and  must  be 
the  subject  of  serious  inquiry.  Such  a  claim 
cannot  be  treated  as  a  mere  subterfuge  to  avoid 
punishment,  but  should  receive  the  same  atten- 
tion that  a  claim  of  insanity  or  self-defence  would. 
This  is  only  an  outline  view  of  a  very  wide  and 
most  practical  field  of  medico-legal  research, 
largely  unknown,  which  can  be  seen  in  every 
court-room  of  the  land.  These  cases  appeal 
to  us  for  help  and  recognition,  and  the  highest 
dictates  of  humanity  and  justice  demand  of  us 
an  accurate  study  and  comprehension  of  their 
nature  and  character. 

The  following  summary  of  the  leading  facts  in 
this  trance  condition  will  be  a  standpoint  for 
other  and  more  minute  investigations  : 

ist.  The  trance  state  in  inebriety  is  a  distinct 
brain  condition,  that  exists  beyond  all  question 
or  doubt. 


ALCOHOLIC  TRANCE  297 

2iid.  Tliis  brain  state  is  one  in  which  all 
memory  and  consciousness  of  acts  or  words 
are  suspended,  the  person  going  about  auto- 
matically, giving  little  or  no  evidence  of  his  real 
condition. 

3rd.  The  higher  brain  centres  controlling  con- 
sciousness are  suspended,  as  in  the  somnambu- 
listic or  hypnotic  state.  The  duration  of  this 
state  may  be  from  a  few  moments  to  several  days, 
and  the  person  at  this  time  may  appear  conscious 
and  act  naturally,  and  along  the  line  of  his 
ordinary  life. 

4th.  During  this  trance  period,  crime  against 
person  or  property  may  be  committed  without 
any  motive  or  apparent  plan,  usually  unforeseen 
and  unexpected.  When  accurately  studied  such 
a  crime  will  lack  in  the  details  and  methods  of 
execution,  and  also  show  want  of  consciousness 
of  the  nature  and  results  of  such  acts. 

5th.  When  this  condition  passes  away,  the  acts 
and  conduct  of  the  person  show  that  he  did  not 
remember  what  he  had  done  before.  Hence  his 
denial  of  all  recollection  of  past  events,  and  his 
changed  manner  confirm  or  deny  his  statements. 

6th.  When  such  cases  come  under  judicial 
inquiry,  the  statement  of  the  prisoner  requires  a 
scientific  study  before  it  can  be  accepted  as  a 
probable  fact.  It  cannot  be  simulated,  but  is 
susceptible  of  proof  beyond  the  comprehension 
of  the  prisoner. 

7th.    In    such    a    state    crime    and    criminal 


298  MODERN  TREATMENT  OF  ALCOHOLISM 

impulses  are  the  result  of  unknown  and  unfore- 
seen influences,  and  the  person  in  this  condition 
is  dangerous  and  an  irresponsible  madman. 

8th.  This  condition  should  be  fully  recognised 
by  Court  and  jury,  and  the  measure  of  responsi- 
bility and  punishment  suited  to  each  case. 
They  should  not  be  punished  as  criminals,  nor 
should  they  be  liberated  as  sane  men.  They 
should  be  housed  and  confined  in  hospitals. 


CHAPTER    VI 

ETHER   INEBRIETY 

Personally,  I  have  never  met  with  a  case  of 
inebriety  due  to  ether  drinking,  and  cannot, 
therefore,  think  that  the  habit  has  obtained  much 
hold  in  England,  whatever  may  be  the  facts 
regarding  Ireland  or  Scotland  ;  but  the  following, 
quoted  from  the  Journal  of  the  American  Society 
for  the  Study  and  Cure  of  Inebriety,  makes  it  plain 
that  Ireland  at  least  has  suffered  severely  from 
this  form  of  inebriety.  The  writer  of  the  article 
says : 

"  Ireland  has  in  the  nineteenth  century  pre- 
sented to  the  world  two  interesting  and  remark- 
able series  of  inebrio-psychological  phenomena. 
In  1838,  a  simple-minded  Roman  Catholic  priest, 
Father  Mathew,  adopted  and  began  to  advocate 
the  practice  of  abstinence  from  all  intoxicating 
drinks.  So  amazing  was  the  impression  made 
by  him,  that,  in  three  years,  the  roll  of  the  teetotal 
pledges  which  he  had  administered  exceeded  five 
millions  in  Ireland,  in  addition  to  large  numbers 


300  MODERN  TREATMENT  OF  ALCOHOLISM 

in  England,  Scotland,  and  America.  The  reality 
of  this  epidemic  of  temperance  was  attested  by 
the  statement  of  the  Chief  Secretary  in  1840, 
that  '  the  duties  of  the  military  and  police  in 
Ireland  are  now  almost  entirely  confined  to 
keeping  the  ground  clear  for  the  operation  of 
Father  Mathew.'  " 

Though  this  great  wave  of  sobriety  has  gradu- 
ally receded,  till  now  the  extent  of  drinking  in 
Erin  is  simply  terrible.  I  am  every  now  and  again 
meeting  professionally  with  sons  and  daughters 
of  Hibernia  who  glory  in  their  steadfastness  to 
the  pledge  which  they  so  long  ago  took  at  the 
hands  of  the  Irish  apostle  of  temperance.  An 
accurate  study  of  this  unique  crusade  would, 
in  psychological  results,  amply  repay  the  labours 
of  any  earnest  student  of  mental  science. 

Curious  to  relate,  the  other  series  of  inebrio- 
psychological  phenomena  is  an  experience  in  an 
opposite  direction — an  experiment,  so  to  speak, 
not,  as  in  the  former  case,  in  temperance,  but  in 
intemperance. 

The  disease  of  inebriety  or  narcomania  (a 
mania  for  intoxication  by  any  kind  of  narcotic 
or  anaesthetic)  may,  besides  other  phases,  assume 
a  form  correspondent  to  the  particular  inebriating 
substance.  It  ma}^  therefore,  be  interesting  to 
glance  at  the  origin  and  growth  of  this  new  mode 


ETHER  INEBRIETY  301 

of  inebriate  indulgence,  as  this  is  the  first  oppor- 
tunity afforded  to  us  of  observing  the  rise  and 
progress  of  such  a  process  in  a  community. 

The  centre  from  which  ether  drinking  spread 
was  the  town  of  Draperstown  (with  a  population 
of  some  three  hundred),  in  the  southern  part  of 
the  county  of  Londonderry.  Before  Father 
Mathew's  abstinence  propaganda,  ether  drinking 
was  there  unknown.  Between  1842  arid  1845  a 
local  medical  practitioner,  in  response  to  a  request 
from  a  few  newly-pledged  abstaining  converts 
for  something  the  taking  of  which  would  not 
violate  their  vow,  gave  them  a  drachm  of  ether 
in  water.  So  far  as  I  can  ascertain  this  was 
the  fons  et  origo  mali.  A  desire  for  more  frequent 
doses  grew  upon  the  ether  drinkers,  and  the 
practice  spread  in  and  around  Draperstown,  till 
there  was  a  shop  for  the  sale  of  ether  in  one  town 
to  every  twenty-three  of  the  population.  In  the 
session  of  1855-56  an  Act  was  passed  by  the 
British  Legislature,  allowing  spirits  of  wine  to  be 
used  duty-free  in  arts  and  manufactures,  provided 
it  was  made  nasty  as  a  drink  (which  the  Govern- 
ment in  their  innocence  supposed  would  prevent 
people  from  drinking  it),  by  the  addition  of  a 
minimum  of  1-9  of  methylated  spirit.  As  ether 
prepared  in  this  way  is  much  cheaper  than 
ordinary  sulphuric  ether,  this  cheap  production 


302  MODERN  TREATMENT  OF  ALCOHOLISM 

of  "  methylated  ether  "  caused  the  consumption 
to  increase  "  by  leaps  and  bounds." 

The  present  ether  area  was,  from  its  mountain- 
ous features,  a  central  locality  for  the  illicit  dis- 
tillation of  whisky.  Owing  to  the  activity  of  the 
police  and  the  making  of  roads,  this  illicit  traffic 
was  eventually  stamped  out.  The  disappointed 
cheap  whisky  drinkers  found  a  cheap  unintoxicant 
in  ether.  Mr.  H.  N.  Draper  iirst  called  attention 
to  Irish  ether  drinking  in  1877,  followed  by 
D.  B.  W.  Richardson  about  1879,  and  by  Mr. 
Ernest  Hart  in  1890. 

Ether  drinking  was  in  a  year  or  so  gradually 
introduced  from  Draperstown  into  the  neighbour- 
ing town  of  Maghera,  and  soon  extended  its  sway 
till  it  occupied  an  area  of  somewhere  about 
295  square  miles,  with  a  population  of  nearly 
79,000  souls.  This  area  may,  in  general  terms, 
be  said  to  comprise  the  mountainous  districts, 
especially  of  Derry  and  Tyrone,  and  to  some 
extent  of  Armagh  and  Antrim.  Cases  of  ether 
intoxication  have  occurred  in  Dubhn  and  other 
parts  of  Ireland,  in  Glasgow  (Scotland),  in  Lin- 
colnshire in  England,  and  I  have  seen  several 
in  London. 

All  the  cases  which  I  have  seen  in  England 
have  been  persons  of  education  and  refinement, 
who    had    first    been    alcoholic    inebriates    and 


ETHER  INEBRIETY  303 

gradually  developed  into  devotees  of  these  twin 
poisons.  Nearly  all  of  these  Enghsh  cases  have 
been  females,  the  only  males  having  been  members 
of  the  medical  profession.  In  Ireland,  women 
assert  the  equality  of  the  sexes  by  taking  their 
fair  share  of  this  form  of  intemperance.  Small 
farmers  and  agricultural  labourers  make  up  the 
bulk  of  the  Irish  ether  tipplers.  Workmen,  too, 
are  well  to  the  front.  But  the  practice  is  by  no 
means  confined  to  these  classes.  Members  of  the 
learned  professions  have  their  representatives. 
Etherists  are  to  be  found  at  almost  all  ages  from 
puberty  onwards.  Sturdy  Irish  lads  and  beauti- 
ful Irish  lasses,  brimful  of  Hibernian  wit,  as  well 
as  "  sixty-year  olds  "  of  both  sexes,  are  slaves 
to  ether  drunkenness.  The  mother  may  be  seen 
with  her  daughters,  and  maybe  a  neighbouring 
Irishwoman  or  two,  at  a  friendly  ether  **  bee." 
The  habit  has  become  so  general,  that  small  shop- 
keepers treat  the  children  who  have  been  sent  to 
purchase  some  article  with  a  small  dose  of  ether, 
and  schoolmasters  have  detected  ether  on  the 
breaths  of  children  from  ten  to  fourteen  (or  even 
younger),  on  their  arrival  at  school. 

Some  critics  have  endeavoured  to  lay  the  blame 
of  this  new  development  of  inebriety  on  the 
Roman  Catholic  religion.  Nothing  could  be 
more  unwarrantable  and  unfair.     The  disease  has 


304  MODERN  TREATMENT  OF  ALCOHOLISM 

spread  principally  among  Roman  Catholics  simply 
because  this  is  the  creed  of  the  greater  part  of  the 
population.  One  Protestant  village,  Tobermore, 
is  as  bad  as  any  other  place.  All  m}^  cases  have 
been  Protestants. 

The  amount  swallowed  at  a  draught  varies 
mainly  with  the  stage  of  education  in  ether 
consumption.  A  novice  will  find  a  drachm  (a 
teaspoonful)  sufficient.  Gradually  the  wished- 
for  effect  demands  an  increased  dose,  till  J  of  an 
oz.  may  in  time  become  the  ordinary  "  peg  "  of  an 
accomplished  drinker,  to  use  the  phraseology  of 
Anglo-Indians.  These  are  average  quantities 
of  a  so-called  "  moderate  "  drinker.  More 
**  seasoned  casks  "  have  a  higher  capacity,  many 
toping  off  a  half  a  wineglassful  as  unconcernedly 
as  an  average  Englishman  would  drink  a  glass  of 
claret,  or  an  average  American  a  glass  of  cham- 
pagne. 

The  amount  of  ether  consumed  in  a  day  is 
often  remarkable.  A  confirmed  ether  inebriate 
will  take  a  much  larger  dose  than  any  I  have  just 
enumerated,  and  repeat  the  dose  three,  four,  five, 
or  even  six  times  in  the  twenty-four  hours  when 
"  on  the  spree."  Indeed,  in  some  cases,  half  a 
pint  has  been  the  regular  daily  allowance  of 
constant  (or  habitual)  inebriates.  In  England 
I  have  known  an  ether  inebriate  use  a  pint  of 


ETHER  INEBRIETY  305 

ether  by  inhalation  every  day.  In  Ireland,  many 
persons  keep  themselves  intoxicated  pretty  well 
during  the  day  for  the  sum  of  sixpence — taking 
two  pennyworth  at  ten  o'clock,  one  o'clock,  and 
four  o'clock.  What  a  paradise  for  drunkards  ! 
Drunk  three  times  a  day  for  thirteen  cents  ! 

In  England,  in  my  own  practice,  the  majority 
of  ether  drmkers  have  inhaled  the  poison.  In 
Ireland,  the  universal  method  is  drinking.  By 
the  latter  mode  the  ether  is  taken  "  neat."  Owing 
to  an  idea  that  ether,  like  whisky  or  brandy, 
should  be  drunk  diluted  with  water  to  sheathe 
the  virulence  of  the  poison,  the  uninitiated  and 
ignorant  Englishman,  when  in  Ireland,  some- 
times mixes  his  ether  "  peg"  with  water,  "  just 
to  try  the  stuff,  you  know."  Ludicrous  failure 
awaits  him  ;  for,  unlike  ardent  spirits,  ether  is  but 
sparingly  soluble  in  water.  The  pungency  of 
ether,  except  to  those  who  have  "  finished  their 
education,"  generally  calls  for  an  "  overture"  to 
the  "  act  "  of  ether  swallowing.  Scene  I. — The 
mouth  is  washed  out  with  cold  water.  Scene  11. 
A  draught  of  cold  water  is  drunk.  Scene  III. — 
The  ether  is  swallow^ed  "  neat."  Scene  IV. — The 
performance  closes  with  a  second  and  final  drink 
of  cold  water. 

The  preliminary  draughts  of  water  are  to  cool 
the  mouth  and  throat,  and  the  post-ether  draught 
20 


3o6  MODERN  TREATMENT  OF  ALCOHOLISM 

is  to  "  keep  the  ether  from  rising."  The  washing 
of  the  mouth  is  soon  omitted.  By  and  by  the 
preliminary  draught  of  water  follows  the  same 
fate,  the  ether  dose  and  the  succeeding  draught 
of  water  being  the  commonest  method.  As  his 
education  advances,  the  etherist  dispenses  with 
water  altogether.  He  may  for  a  while,  especially 
when  drinking  an  unusually  large  dose,  hold  his 
nose  with  one  hand,  but  probably  ends  by  de- 
spising all  precautionary  safeguards,  and  by 
simply  drinking  his  mouthful  of  ether  at  a 
gulp. 

Ether  purus  of  the  British  Pharmacopoeia  was 
at  one  time  affected  by  my  inebriate  patients. 
This  pure  ether  {CM^)^,  which  is  free  from 
alcohol  and  water,  has  been  in  my  hands  the 
only  ether  preparation  which  has  proved  to  be 
without  complicatory  drawbacks  when  used  as  an 
anaesthetic  (Brit.  Pharmacopoeia,  720  ;  U.S.  725). 
Ether  of  the  B.P.  (sulphuric  ether)  was,  however, 
the  article  generally  used  for  purposes  of  in- 
toxication. It  contains  8  per  cent,  of  alcohol  and 
water  with  92  per  cent,  of  ether  purus,  and  is 
soluble  in  all  proportions  with  rectified  spirit,  but 
in  only  i  in  10  with  water.  The  specific  gravity 
should  be  (B.P.)  735 ;  (U.S.)  750.  It  is  a  swift, 
potent,  diffusible  stimulant,  narcotic,  anaesthetic, 
and  antispasmodic,  of  great  value  in  medicine. 


ETHER  INEBRIETY  307 

It  has  a  strong,  penetrating  odour,  is  sweetish, 
hot,  burning  and  pungent  to  the  palate. 

To  America  the  whole  world  owes  a  deep  debt 
of  gratitude  for  the  introduction  of  ether  as  an 
anaesthetic  by  Dr.  Morton,  in  Boston,  in  1846, 
and  any  saddening  misuse  of  this  grand  mode 
of  alleviating  human  suffering  ought  not  to 
lessen  our  appreciation  of  this  splendid  boon  to 
humanity. 

By  the  Act  18  and  19  Vict.,  the  use  of  spirit 
of  wine,  free  of  duty,  was  permitted  in  the  arts 
and  manufactures,  on  the  addition  of  a  minimum 
of  1-9  of  wood-naptha  (methylic  alcohol  or 
spirit  from  the  destructive  distillation  of  wood, 
after  rectification  ;  specific  gravity,  -803  B.P.), 
with  a  view  to  prevent  this  fouled  liquid  from 
being  drunk  as  a  beverage.  Ether  prepared 
from  this  fouled  duty-free  spirit  is,  of  course, 
much  cheaper  than  ether  prepared  from  spirit 
of  wine,  on  which  duty  has  to  be  paid.  The 
intention,  however,  was  defeated,  inasmuch  as 
in  the  process  of  manufacture  of  ether  from  the 
fouled  spirit,  the  fouling  ingredients  (i.e.  the 
methyl  products)  are  destroyed.  Thus,  contrary 
to  the  general  belief  in  what  is  commonly  called 
"  methylated  ether "  being  as  nasty  as  the 
methylated  spirit  which  is  used  for  lamps  and 
polishing    purposes,    "  methylated   ether  "    is  to 


3o8  MODERN  TREATMENT  OF  ALCOHOLISM 

the  taste  hardly  discernible  from  pure  sulphuric 
ether.  This  so-called  "  methylated  ether  "  is 
practically  undistinguishable  from  ether  (B.P.)  at 
the  specific  gravity  of  717,  i.e.,  when  purified. 
At  any  other  specific  gravity  an  odour  is  given 
off  after  evaporation.  Practically,  one  cannot 
discriminate  between  the  ethylic  and  methylic 
productions. 

Price. — The  ether  thus  prepared  from  the  duty- 
free spirit  (sp.  vin.  rect.  cum  methylic  alcohol)  can 
be  produced  at  as  low  as  one-seventh  of  the  cost 
of  ether  prepared  from  the  duty-paid  spirit,  the 
latter  being  bought  wholesale  at  Si. 25  per  lb., 
and  the  former  at  as  low  as  16  cents. 

Ether  is  imported  mostly  from  England, 
partly  from  Scotland,  by  larger  chemists  and 
druggists  in  the  principal  towns  of  Cookstown, 
Magherafelt,  and  Maghera.  The  large  dealers 
supply  small  shopkeepers,  and  also  cottagers, 
who  sell  in  "  draughts  "  (rather  less  than  two 
teaspoonfuls)  for  one  penny.  The  small  shop- 
keepers also  supply  the  hawkers  (who  are  very 
often  women),  who  attend  fairs  and  other  festive 
gatherings  to  dispense  the  "  draughts  "  of  the 
liquid  poison.  These  draughts  are  also  to  be 
had  from  the  surgeries  of  some  medical  practi- 
tioners, and  in  cottages  or  ether  shebeen,  where 
the  cottager  keeps  a  pig  or  two,  and  sells  ether. 


ETHER  INEBRIETY  309 

the  country  people  frequently  giving  potatoes, 
meal,  or  other  produce  in  exchange.  The  hawkers 
carry  about  a  bottle  of  ether,  and  do  not  scruple 
at  selling  to  any  one,  however  young,  bartering  a 
little  for  one  or  two  eggs.  In  this  way  the  children 
may  procure  the  ether  on  their  way  to  school. 

Intoxication  by  ether  presents  one  distinguish- 
ing feature  as  compared  with  alcoholic  intoxi- 
cation. The  phenomena  are  practically  alike, 
but  in  rapidity  of  manifestation,  alcohol  is  "  no- 
where." Indeed,  in  this  respect,  ether  beats 
the  record.  There  is  the  exhilarative  stage  of 
morbid  exaltation,  when  the  fun  and  exuberant 
merriment,  the  latent  and  ineradicable  impulse 
of  one  "  spoiling  for  a  fight  "  of  the  genuine 
Irishman  stands  revealed  in  the  twinkle  of  the 
eye  and  the  flourish  of  the  shillelagh.  The 
pleasing  but  quickly  vanishing  whirl  of  enjoy- 
ment is  followed  by  an  evanescent  episode  of 
brain  disturbance  and  mental  riot,  with  muscular 
disturbance  and  inco-ordination.  To  these  suc- 
ceeds the  concluding  comatose  stage,  when  the 
patient  is  said  to  be  "  dead  drunk."  The  shortest 
period  in  which  I  have  seen  this  inebriate  pano- 
rama move  on  till  it  swung  round  to  recovered 
sobriety  has,  with  alcohol,  been  six  hours.  With 
ether,  I  have  witnessed  the  entire  revolution  in 
less  than  two  hours. 


310  MODERN  TREATMENT  OF  ALCOHOLISM 

In  my  observation  an  alcoholic  inebriate  career, 
from  start  to  fatal  finish,  has  in  America  been,  on 
an  average,  one-third  of  the  duration  of  a  corre- 
sponding career  in  Britain.  So,  curious  to  say,  has 
the  length  of  an  ether  intoxicative  paroxysm  been 
one-third  the  length  of  an  alcoholic  intoxicative 
paroxysm.  Thus  the  etherist  can  have  three 
thorough  "  drunks  "  for  one  of  the  alcoholist. 
Herein,  in  addition  to  the  greater  cheapness,  lies 
the  superior  claim  of  ether  to  the  "greedy  for 
intoxication,''  the  true  "  narcomaniac." 

Intoxication  by  ether  may  be  described  as 
"  hysterical,"  and  intoxication  by  ether  cum 
alcohol  as  "  maniacal."  A  man  arrested  while 
drunk  on  ether  alone  would  probably  be  quite 
sober  by  the  time  the  constable  had  him  at  the 
police  station,  which  might  be  very  awkward 
for  the  constable,  though  the  arrest  had  been 
made  when  the  man  was  in  a  frenzy  of  boisterous 
excitement.  Several  deaths  from  ether,  and 
ether  cum  alcohol,  have  occurred. 

Little  is  known  of  the  pathology  of  ether.  The 
habit  has  been  too  young  to  afford  opportunities 
of  much  port-mortem  examination  of  ether 
inebriates.  Premature  old  age,  an  antedated 
shrivelling  up  of  the  living  frame,  attests  the 
poisonous  influence  of  the  destroying  agent. 
Gastritis  (acute  and  chronic),  debility,  dyspeptic 


ETHER  INEBRIETY  311 

distress,  epigastric  pain,  pallors,  tremors,  timidity, 
moroseness,  suspicion,  nervous  prostration,  chilli- 
ness, a  cyanosed  or  lemon  skin,  and  an  inter- 
mittent heart-beat,  with  exaggerated  reflexes, 
are  prominent  symptoms.  I  have  one  such 
victim  in  my  mind's  eye  now.  Fawning,  cunning, 
terror-stricken,  this  wretched  medical  colleague 
is  the  incarnation  of  utter  misery.  Not  yet 
forty  years  of  age,  he  shuffles  about  like  a  worn- 
out  old  man  of  ninety,  after  a  wasted  and  mis- 
spent life.  It  has  been  urged  by  some  medical 
authorities  that  ether  is  guiltless  of  producing 
any  pathologial  lesion,  from  the  almost  lightning 
rapidity  with  which  its  inebriating  manifestations 
appear  and  fade  away,  and  from  no  serious,  morbid 
after-death  appearances  having  been  observed. 

This  conclusion  is,  in  my  judgment,  premature. 
Judging  from  the  symptoms  from  which  I  have 
seen  ether  inebriates  suffer,  I  have  not  the  slightest 
doubt  that  ether  has  a  pathological  influence 
on  various  organs  and  tissues,  and  that,  if  ether 
drinking  could  boast  of  as  venerable  an  antiquity 
as  alcohol  drinking,  unmistakable  lesions  would 
have  been  but  too  manifest.  What  are  the  forty 
years  of  ether  consumption  by  a  hundred  thousand 
persons,  to  the  thousands  of  years  of  alcohol  by 
at  least  as  many  millions  of  human  beings  ? 

Happily,  this  new  form  of  inebriation  is  but  in 


312  MODERN  TREATMENT  OF  ALCOHOLISM 

its  infancy,  so  there  is  some  hope  that  its  growth 
may  be  "  nipped  in  the  bud."  As,  in  the  con- 
version of  methylated  spirit  into  ether,  the 
nauseous  methyl  products  are  destroyed,  some- 
thing might  be  done  towards  making  the  liquor 
loathsome  to  the  palate  by  the  compulsory 
addition  of  the  wood  spirit  after  the  completion 
of  the  etherilication,  before  the  sale  of  the  liquid. 
This,  however,  would  be  but  a  palliative,  for  I 
have  had  patients  under  my  care  who  drank 
methylated  spirit  (some  even  from  jars  with 
anatomical  preparations) ;  and  in  Edinburgh  and 
Glasgow,  Sunda}^  drinking  of  this  nasty  beverage 
recently  flourished  apace.  In  a  certain  locality 
in  the  North  of  Ireland,  the  drinking  of  methyl- 
ated spirit  was  introduced  seven  or  eight  years 
ago.  At  first  confined  to  the  very  poor  in  a  hilly 
district,  it  has  spread  rapidly,  till  now  farm 
labourers  and  farmers  are  daily  indulging  in  it. 

There  are  many  inebriates  who  hate  and  abhor 
the  taste  of  the  intoxicant  which,  in  their  narco- 
maniac madness,  they  would  barter  their  salvation 
to  procure. 

Another  remedy  would  be  the  abolition  of  the 
retail  sale.  This  would  help  by  putting  diffi- 
culties in  the  way  of  the  drinker,  but  would  only 
mitigate  the  mischief.  Still  more  effectual  would 
be  the  scheduling  of  ether  as  poison,  the  sale  of 


ETHER  INEBRIETY  313 

which  is  restricted  to  druggists  under  certain 
safeguards.  This  course  was  so  readily  adopted 
for  Ireland  by  the  British  Government  in  January 
last,  that  I  have  yet  hope  the  day  will  come  when 
the  more  deadly  allied  poison — alcohol — will  be 
placed  in  the  same  category,  and  so  dangerous  a 
drug  will  be  relegated  to  the  shelf  of  the  apothe- 
cary, its  sale  hedged  in  with  as  stringent  pre- 
cautions as  is  now  the  sale  of  arsenic  or  prussic 
acid.  But  this  halcyon  era  of  prohibition  will 
only  be  attained  after  a  prolonged  struggle,  amid 
the  howls  and  groans  of  an  enraged  liquordom, 
whose  indignation  is  concentrated  on  all  who 
attempt  "  to  rob  the  poor  man  of  his  beer." 

It  is  too  soon  yet  to  foretell  the  ultimate  result 
of  the  bold  step  taken  by  our  Government  in 
scheduhng  ether  as  a  poison,  but  it  has  made  the 
procuring  of  ether  for  drinking  purposes  so  diffi- 
cult that  at  present  the  sale  has  diminished  by 
at  least  75  per  cent.  I  fear,  however,  that  the 
cupidity  of  some  wholesale  dealers  will  incite 
them  to  risk  the  penalties  of  the  law  by  sur- 
reptitious sales,  which  will  speedily  be  ferreted  out 
by  the  marvellous  cunning  of  the  diseased  and 
demoralised  inebriate. 

The  lines  of  sound  treatment  of  ether  inebriety, 
and  of  its  prevention  by  law,  must  ahke  be  based 
on  an  intelligent  appreciation  of  the  true  char- 


314    MODERN  TREATMENT  OF  ALCOHOLISM 

acter  and  etiology  of  ether  drunkenness.  This 
is,  in  reaUty,  but  a  new  manifestation  of  an 
underlying  morbid  condition  which  renders 
certain  of  the  sons  and  daughters  of  men  peculi- 
arly liable  to  plunge  into  intoxication.  We  can 
never  hope  to  succeed  in  the  cure  and  prevention 
of  any  disease  until  we  first  recognise  the  presence 
of  the  disease  itself.  The  malady  of  narcomania, 
as  subtle  as  it  is  far-reaching  in  its  influence  on 
body,  brain  and  mind,  and  morals,  is  a  legitimate 
outcome  of  natural  law,  and  we  will  not  be 
adequately  equipped  for  the  fight  till  we  are 
thoroughly  conversant  with  the  laws  under  which 
every  form  of  the  disease  of  inebriety  is  developed 
and  propagated. 

The  late  Norman  Kerr  refers  to  the  subject  of 
ether  drinking  as  follows  : — 

"  In  a  locality  in  the  North  of  Ireland,  ether 
drinking  has  prevailed  for  nearly  half  a  century. 
The  evils  which  have  arisen  there  from  this 
species  of  inebriety  are  so  serious  that  the  atten- 
tion of  the  Presbytery  of  Armagh  was  recently 
called  to  the  practice.  The  good  and  single- 
hearted  Theobald  Mathew  administered  the 
teetotal  pledge  to  nearly  six  million  Irishmen ; 
but  as  the  influence  of  his  wondrous  and  saintly 
labours  began  to  fade,  a  drink  was  introduced  into 
the  locality  in  question,  for  which  powers  of 
exhilaration  and  stimulation  were  claimed,  and 


ETHER  INEBRIETY  315 

of  which  it  was  asserted  that  it  was  not  whisky, 
could  not  intoxicate,  and  was  harmless.  Ether 
inebriates  are  to  be  seen  to-day  in  this  com- 
munity of  ether  drinkers.  There  are  individuals 
who  partake  of  this  anaesthetic  in  limited  quantity, 
as  there  are  multitudes  in  the  rest  of  the  United 
Kingdom  who  are  '  moderate  '  drinkers  of 
alcohol.  A  glass  of  sulphuric  ether  is  drunk  as 
unconcernedly  as  a  glass  of  Irish  whisky  in  other 
parts  of  Ireland,  especially  if  the  mouth  be  rinsed 
out  with  cold  water  first.  There  are  many  ether 
inebriates  who  drink  large  amounts  of  this  rapid 
and  volatile  inebriant.  A  few  fatal  cases  have 
occurred. 

"The  intoxication  of  ether  is  more  rapid  than 
that  of  alcohol,  and  even  more  lively.  It  is 
more  effervescent  and  sparkling,  and,  though 
unconsciousness  may  have  been  reached,  it  is 
much  more  evanescent  in  its  effects.  The  whole 
drama  of  ether  exhilaration,  drunkenness,  and 
dead  drunkenness,  with  a  return  to  sobriety,  is 
often  performed  in  little  more  than  half  the  time 
occupied  by  a  similar  alcoholic  performance. 
Etherism  is  the  antipodes  of  opiumism.  The 
intoxicated  by  ether  are  merry,  frisky,  and 
mercurial.  The  intoxicated  by  opium  are  serene, 
sedate,  and  lethargic.  But,  like  opium,  ether 
does  not  appear  to  set  up  a  permanent  patho- 
logical change  of  organic  or  connective  tissue.  In 
this  respect  both  these  substances  differ  from 
alcohol. 


3i6  MODERN  TREATMENT  OF  ALCOHOLISM 

"  I  may  refer  to  two  cases  in  England,  one  a 
medical  man,  the  other  a  lady.  The  former  is 
forty-six  years  of  age,  of  a  nervous  temperament. 
No  known  inebriate  heredity.  At  first  he  took 
chloral  and  opium,  then  he  devoted  himself  to 
ether,  and  has  been  an  etherist  for  some  four 
years.  At  first  irregularly  periodical,  he  has  now 
become  a  constant  inebriate,  will  he,  cheat,  or 
steal  to  procure  a  fresh  supply. 

"The  other  is  an  elderly  lady,  who  was  addicted 
to  chloral  for  some  eight  or  nine  years.  She 
then  became  alarmed  on  account  of  the  extreme 
feeling  of  cardiac  weakness  which  she  experienced, 
and  she  resorted  to  ether.  Her  approach  is 
heralded  by  the  characteristic  odour  long  before 
she  is  seen,  and  she  returns  to  her  intoxicant  as 
soon  as  the  effects  of  the  previous  dose  have 
passed  aw^ay." 


Chloroform  Inebriety 

Whether  this  fascinating  habit  has  obtained 
any  hold  in  this  country  or  not,  it  is  difficult  to 
say,  for  the  practice  is  a  very  secret  one,  and  it  is 
only  in  the  last  stages  of  the  disease  that  the 
patients  seek  medical  advice  ;  and  as  they  do  not 
present  themselves  at  the  usual  Inebriate  Homes, 
it  is  to  be  presumed  that  they  are  attended 
privately  by  the  family  physician.  That  the 
habit  could  be  easily  acquired  is  well  known  to  all 


CHLOROFORM  INEBRIETY  317 

physicians  who  administer  the  drug  during  labour, 
as  the  patients  frequently  beg  for  some  more  of 
that  delightful  stuff  which  gave  them  such 
beautiful  dreams.  I  have  already  related  my 
personal  experience  of  the  fascination  of  the  drug, 
but  the  following  vivid  picture  of  chloroform 
inebriety  is  so  instructive  that  I  have  quoted  it 
in  full  from  the  Journal  of  the  American  Associa- 
tion for  the  Study  and  Cure  of  Inebriety. 

"  The  following  history  of  a  case  is  so  graphic 
and  full  of  suggestions  as  to  give  the  reader  a 
good  idea  of  such  cases  : 

"He  says  :  '  With  me  the  chloroform  infatua- 
tion was  a  case  of  love  at  first  sight.  I  had  been 
always  temperate,  almost  a  total  abstainer  from 
stimulants  of  all  kinds.  Once  or  twice  I  had 
smelt  chloroform,  and  thought  its  odour  pleasant. 
I  was  a  young  man  just  finishing  my  education, 
and  fond  of  study.  I  had  had  some  curiosity 
to  know  what  it  was  like  to  be  put  to  sleep  with 
chloroform,  and  one  night  I  happened  to  see  a 
i-oz.  bottle  of  chloroform  which  was  bought 
for  toothache.  I  took  the  bottle  home  with  me, 
and  when  I  went  to  bed  put  a  little  of  the  chloro- 
form on  a  handkerchief,  and  for  the  first  time 
felt  the  delightful  sensation  of  being  wafted 
through  an  enchanted  land  into  Nirvana.  Those 
who  know  nothing  of  intoxication,  except  in  the 
vulgar  form  produced  by  whisky,  have  yet  to 


3i8  MODERN  TREATMENT  OF  ALCOHOLISM 

learn  what  power  there  can  be  in  a  poison  to 
create  in  a  moment  an  Elysium  of  delight.  It  is 
a  heaven  of  chaste  pleasures.  What  I  most 
remember  is  the  vivid  pictures  that  would  seem 
to  pass  before  my  eyes — creations  of  marvellous 
beauty — every  image  distinct  in  outline,  perfect 
in  symmetry,  and  brilliant  in  colouring.  The 
enjoyment  is  purely  passive  ;  you  have  only  to 
watch  vision  after  vision  ;  but  why  each  vision 
seems  more  wonderful  and  charming  than  the 
last  you  cannot  tell,  and  you  do  not  stop  to 
question. 

"  '  I  suppose  that  it  was  an  unfortunate  circum- 
stance for  me  that  I  had  never  been  drunk  before 
in  my  life,  and  I  never  thought  of  comparing  my 
blissful  condition  with  that  of  the  wTetches  I  had 
sometimes  seen  staggering  through  the  streets. 
I  had  made  a  great  discovery.  I  had  found  a 
golden  gate  into  dreamland — dangerous,  iadeed, 
to  approach,  I  knew  that,  but  who  would  heed 
any  danger  where  the  prize  to  be  obtained  was  so 
great  ?  and,  guarding  jealously  my  secret,  I  took 
care  night  after  night  to  have  by  me  the  key 
to  that  golden  gate.  Probably  I  inhaled  from 
half  a  drachm  to  a  drachm  or  two  each  time. 
Generally  I  did  not  waken  again  until  morning, 
and  my  sleep  seemed  to  be  just  as  refreshing  as 
usual,  only  now  and  then  I  would  wake  with  a 
trifling  headache,  and  feel  disposed  to  lie  a  little 
longer  in  bed  than  common.  My  bodily  condition 
did  not  seem    to  suffer    in    the  least,   and    my 


CHLOROFORM  INEBRIETY  319 

faculties  all  seemed  as  keen  as  ever.  I  felt  no 
craving  for  my  pet  intoxicant  during  the  day — 
did  not  give  it  a  thought  often  until  bedtime 
came,  and  then  it  would  occur  to  me  for  a 
moment  to  try  and  see  how  it  would  seem  to  go 
to  sleep  in  the  ordinary  way,  the  conclusion  always 
being  that — to-morrow  night  I  would  make  the 
experiment.  So,  before  I  knew  it,  I  was  a  slave. 
I  would  say  to  myself,  "  It  does  not  hurt  me  ; 
it  seems  to  have  no  more  effect  than  the  cigar 
my  friend  smokes  after  dinner.  Really  I  believe 
it  is  a  positive  benefit.  It  seems  to  keep  my 
bowels  regular,  and  it  certainly  makes  me  sleep 
soundly  all  night." 

'' '  But  after  a  while  I  found  that  I  was  using  a 
larger  quantity  of  chloroform  than  at  first.  I 
would  take  a  2-oz.  bottle  half  full  of  the 
stuff  to  bed  with  me,  and,  inhaling  directly  from 
the  bottle,  would  forget  at  last  to  cork  it,  and  in 
the  morning  it  would  be  empty.  Sometimes  I 
would  wake  after  midnight,  or  partially  wake, 
to  take  another  dose.  I  found  that  there  was  a 
bad  taste  in  my  mouth  all  the  time,  keeping  me 
in  mind  of  chloroform.  I  was  often  nauseated 
in  the  morning,  and  sometimes  at  intervals 
during  the  day.  I  began  to  feel  a  longing  for 
chloroform  whenever  I  had  a  little  headache,  or 
was  dispirited  from  any  cause ;  and  I  sometimes 
yielded  to  what  I  already  knew  was  a  morbid 
craving.  I  began  to  be  indifferent  to  the  things 
that    personally    had    interested    me,     avoided 


320    MODERN  TREATMENT  OF  ALCOHOLISM 

society,  and  became  depressed  in  spirits.  My 
complexion  became  sallow,  whites  of  the  eyes 
3^ellow,  the  bowels  sometimes  windy  and  un- 
naturally loose,  skin  dry  and  seemingly  bloodless, 
and  injuries  of  che  skin  did  not  heal  rapidly.  In 
winter  there  was  a  tendency  to  chapping,  that 
had  not  before  been  noticed. 

"  '  Meanwhile  I  had  ceased  to  have  visions, 
or  they  came  rarely.  I  began  to  realise  that  my 
pet  habit  was  becoming  my  tyrannical  master. 
I  had  no  special  cares  to  drown,  but  it  became  my 
insane  pleasure  to  draw  over  my  senses  the  veil  of 
oblivion.  I  loved  the  valley  of  the  shadow  of 
death.  I  knew  there  was  danger  that  some  night 
I  would  pass  over  the  line,  into  a  sleep  from  which 
there  would  be  no  waking  ;  but  death  had  no 
terrors  for  me.  Nay,  to  bring  all  my  faculties 
and  powers  and  ambitions  into  the  sweet  oblivion 
of  transient  death,  was  the  one  pleasure  for  which 
I  cared  to  live.  I  was  conscious  of  a  profound 
moral  deterioration  ;  I  became  materialist  ;  I 
had  no  soul  ;  immortality  was  a  dream  of  the 
ignorant  ;  I,  who  had  a  thousand  times  anni- 
hilated my  own  soul  with  my  senses,  knew  that 
the  dream  had  no  corresponding  reality. 

"  '  Yet  all  this  time  I  continued  faithful  in  my 
daily  duties,  and  resisted  successfully  the  tempta- 
tion to  hurry  through  my  evening,  so  as  to  get 
the  sooner  to  my  chloroform.  I  did  not  admit 
to  myself  that  I  was  a  slave  to  the  habit,  or  even 
that  the  habit   was  an  injur}^  to  me,   as  yet  ; 


CHLOROFORM  INEBRIETY  321 

but  I  began  to  be  afraid,  and  the  more  when  I 
found,  when  I  resolved  (as  often  I  did)  to  omit 
my  nightly  indulgence,  just  for  a  week,  how 
impotent  my  will  was  in  the  matter. 

"'This  was  my  condition  at  the  end  of  two 
years.  I  was  still  only  using  a  moderate  quantity 
of  the  chloroform,  about  three  drachms  daily, 
exceeding  that  quantity  only  b}^  accident.  An 
opportunity  offered  for  a  change  of  occupation 
and  surroundings,  w^nch  I  eagerly  seized,  in  the 
hope  that  it  might  enable  me  to  break  my  fetters. 
For  about  three  months,  under  the  new  surround- 
ings, I  abstained  from  chloroform,  and  found  it 
really  not  difficult  to  do  so.  I  began  to  think 
that  I  had  greatly  overrated  the  power  of  the 
habit.  At  all  events,  after  the  first  week  I  had 
no  craving  for  the  stimulant.  But  one  day  I 
came  across  a  bottle  of  chloroform.  When  I  saw 
it  I  smiled  to  myself  to  think  that  I  had  imagined 
myself  a  slave  of  any  such  thing.  Night  came, 
and  when  I  was  ready  for  bed  the  devil  of 
appetite  gave  me  his  commands,  and  I  obeyed. 
Just  one  smell  to  see  whether  I  really  wanted  it  ; 
I  would  not  take  the  bottle  to  bed  with  me.  So 
I  inhaled,  standing,  directly  from  the  bottle — a 
full  pound  of  chloroform — and  with  the  first 
breath  of  the  vapour  came  back,  with  renewed 
force,  all  the  old  appetite,  keener  than  ever 
from  long  abstinence.  Once  more  I  saw  the  old- 
time  visions,  as  beautiful  and  as  vivid  as  at  first. 
One  peculiarity  of  these  visions  I  may  speak  of 
21 


322  MODERN  TREATMENT  OF  ALCOHOLISM 

right  here.  Objects  would  appear  with  wonderful 
sharpness  of  outline  just  as  they  would  be  seen 
with  the  eyes,  only  reduced  to  microscopic  size, 
like  objects  seen  through  an  inverted  telescope. 

"  '  To  go  on  with  my  story.  What  happened 
after  I  got  the  bottle  in  my  hands  I  do  not  know. 
The  next  morning  found  the  bottle  corked  and 
in  its  place,  but  only  half  full  of  chloroform, 
and  I  was  told  that  I  had  been  lying  in  some 
kind  of  a  fit  ;  some  thought  I  was  drunk — as 
indeed  I  was.  From  this  time  I  realised  myself  a 
slave,  but  not  now  a  willing  one.  I  did  not  again 
commence  at  once  the  use  of  the  chloroform, 
but  at  intervals  of  from  three  to  eight  weeks  I 
would  indulge  in  a  regular  spree,  lasting  from  one 
to  three  days,  during  w^iich  I  would  keep  myself 
as  nearly  as  possible  dead  drunk,  and  would 
consume  from  four  to  eight  ounces  of  chloroform. 
All  this  time  I  kept  my  habit  a  secret,  and  con- 
tinued to  do  my  ordinary  work  with  the  usual 
zest  in  the  intervals  between  my  sprees.  At  last 
discovery  came.  You  will  remember  how  I  was 
found  apparently  lifeless,  and  how  by  the  active 
use  of  restoratives  3'ou  brought  me  to  myself. 
How  my  moral  perceptions  were  quickened 
the  moment  I  saw  myself  through  the  eyes  of 
another  ! 

"  '  You  know  that  it  was  not  in  a  week  or  a  year 
that  I  was  placed  morally  on  a  firm  foothold 
again.  Indeed,  you  did  not  know  how  often, 
after  I  had  given  you  and  myself  my  word  and 


CHLOROFORM  INEBRIETY  323 

pledge  to  abstain  wholly  from  chloroform,  I  re- 
lapsed, taken  unawares  by  the  tempter.  For 
more  than  two  years  I  kept  up  the  conflict,  too 
often  thinking  the  final  victory  won,  only  to  find 
there  was  one  imperative  command  it  was  useless 
for  me  to  attempt  to  disobey,  and  that  command 
came  to  me  whenever  the  least  whiff  of  chloro- 
form entered  my  nostrils.  Once  or  twice  I  tried 
the  expedient  of  returning  to  my  first  practice  of 
a  regular  moderate  use  of  the  stimulant,  but  I 
found  that  moderation  was  now  almost  impossible. 
If  I  went  to  sleep  under  the  influence  I  would 
awake  again,  and  find  myself  then  unable  to 
sleep,  distressingly  wide  awake  and  nervous,  until 
I  courted  again  my  '*  dearest  foe."  Symptoms 
like  those  of  delirium  tremens  several  times 
developed.  I  saw  "  things,"  not  now  beautiful 
visions,  but  shadowy  images  that  filled  me  with 
nameless,  irrational  horror.  Appetite  was  cap- 
ricious. I  was  frequently  nauseated,  but  food 
seemed  to  relieve  this  condition  ;  vitality  was 
low,  the  blood  ran  sluggishly  in  my  veins,  and 
seemed  especially  to  desert  the  surface  of  the 
body.  I  suffered  particularly  in  cold  weather, 
and  it  was  during  cold  weather,  m  winter  especi- 
ally, that  I  found  it  almost  impossible  to  resist 
my  besetting  temptation. 

**  *  At  last  I  prevailed  by  sheer  force  of  will.  I 
had  recovered  enough  faith  in  the  soul  to  assert 
my  freedom,  and  I  now  look  back  upon  those 
years  of  conflict  with  a  kind  of  self-pity,  to  think 


324  MODERN  TREATMENT  OF  ALCOHOLISM 

I  could  have  been  so  weak.  But  I  do  not  to-day 
court  temptation.  I  am  not  conscious  of  a  lurk- 
ing appetite,  but  I  dare  not  put  my  virtue  to 
any  severe  test.  I  am  sure,  however,  that  the 
chloroform  habit  is  one  that  can  be  broken  by 
steady  determination.  I  have  no  faith  m  any 
process  of  tapering  off.  It  is  just  as  easy  to  quit 
once  for  all  as  to  prolong  the  agony,  and  the 
suffering  is  often  purely  imaginary.  It  took 
many  months  for  me  to  recover.  If  doctors 
only  knew  the  fascination  of  this  drug  they 
would  seldom  or  never  prescribe  it.  The  danger 
of  the  wine  -  cup  is  nothing  to  that  of  the 
chloroform  bottle.'  " 

Coffee  and  Tea  Inebriety 

As  a  student  at  the  London  Hospital  I  had  my 
attention  directed  to  this  form  of  inebriety.  At 
that  time — 1884 — the  hospital  staff  treated  large 
numbers  of  those  addicted  to  the  excessive  use  of 
tea.  Many  women  sat  all  day  stitching  in  close 
hot  rooms  and  drank  tea  incessantly  ;  after  a 
time  they  were  compelled  to  seek  medical  aid. 
The  following  description  of  this  form  of  in- 
ebriety is  given  by  the  American  Association 
of  Inebriety  : — 

"  Most  physicians  are  doubtless  able  to  recall 
numerous  instances  in  which  coffee  has  induced 


COFFEE  INEBRIETY  325 

more  or  less  serious  symptoms.  It  seems  that 
personal  idiosyncrasies  often  determine  the 
extent  of  the  evil.  The  evils  upon  the  eyes 
and  ears  of  people  are  more  frequent  from  coffee 
than  from  tobacco  or  alcohol.  It  does  not  abso- 
lutely destroy  vision  or  hearing,  but  it  induces 
functional  troubles  very  annoying  to  their 
possessors.  That  coffee  is  the  efficient  agent, 
appears  from  the  fact  that  upon  the  entire 
discontinuance  of  the  use  of  coffee  the  symptoms 
complained  of  disappear. 

"  Dr.  Guelliot  has  published  twenty-three  cases 
of  chronic  caffeism.  Of  these  cases  seventeen 
were  women. 

"The  following  are  the  principal  symptoms: 

"Anorexia,  disturbance  of  sleep,  trembling  of 
the  lips  and  tongue,  attacks  of  gastralgia,  different 
kinds  of  neuralgia,  dyspepsia,  and  leucorrhoea, 
often  profuse.  In  the  twenty-three  cases,  he 
found  in  eighteen,  anorexia  ;  in  sixteen,  disturb- 
ance of  sleep ;  in  sixteen,  trembling  of  the  lips 
and  tongue  ;  in  twelve,  leucorrhoea  ;  in  eleven, 
gastralgia  ;  in  ten,  dyspepsia  ;  in  ten,  neuralgia 
of  various  forms  ;  in  eight,  cephalalgia ;  in  four, 
vertigo  and  convulsive  attacks  ;  in  four,  obstinate 
constipation ;  and  in  three,  constipation  and 
diarrhoea  alternating. 

"  The  patients  had  pinched,  pale,  wrinkled  faces, 
a  weak,  rapid  pulse,  and  the  sleep  was  disturbed 
by  anxious  dreams.  The  following  is  the  account 
of  a  typical  case  :    A  woman  in  middle  life  kept 


326  MODERN  TREATMENT  OF  ALCOHOLISM 

her  pocket  full  of  coffee,  which  she  ate  constantly. 
Her  skin  was  of  an  earthy  tint,  constipation  was 
obstinate,  sleep  very  irregular,  and  her  mind 
restless,  anxious,  and  full  of  forebodings.  She 
was  much  emaciated,  and  both  the  nervous 
system  and  digestion  suffered  severely  at  times. 
The  lips  and  tongue  were  tremulous,  dry,  red, 
and  cracked.  The  appetite  was  very  irregular, 
and  vertigo,  prolonged  headache,  and  epigastric 
pain  were  present  most  of  the  time.  She  was 
placed  under  treatment  and  became  delirious. 
Beef-tea,  milk,  baths,  and  a  mild  galvanic  current 
were  used  for  several  weeks,  and  these  were 
followed  by  bark  tonics.  She  was  discharged 
restored  six  months  later. 

"  The  evil  effects  of  coffee  are  especially  observ- 
able in  children.  The  coffee  drunkard  is  described 
as  having  thin,  pinched  features,  pale,  wrinkled 
face  and  a  greyish  yellow  complexion.  The  pulse 
is  weak,  frequent,  and  compressible.  The  sleep 
is  troubled  with  anxious  dreams. 

"  Although  coffee  does  on  the  whole  far  more 
good  than  evil,  it  is  important  to  bear  in  mind 
the  evils  that  it  is  able  to  produce  under  favouring 
circumstances.  In  a  general  way  it  may  be  said 
that  indoor  brain  workers  do  not  bear  coffee 
as  well  as  outdoor  muscle  workers.  Persons  of 
nervous  temperament  bear  coffee  badly. 

"  The  effects  of  coffee  when  pushed  to  an  excess 
may  be  to  some  extent  confused  by  the  alcohol 
and  tobacco  which  often  accompany  it,  but  they 


COFFEE  INEBRIETY  327 

can  be  studied  more  accurately  in  women,  especi- 
ally in  those  who  do  not  drink  coffee,  but  eat  it. 

"As  a  rule,  both  nervous  system  and  digestion 
suffer  in  these  cases.  The  appetite  fails,  there 
are  attacks  of  sharp  epigastric  pain,  much  vertigo, 
and  prolonged  headache.  There  is  less  insomnia 
than  might  be  supposed  by  those  who  know 
the  weakening  power  of  a  single  cup,  but  much 
dreaming  and  restlessness  of  a  non-aphrodisiac 
type.  The  pulse  is  weak  and  quick,  there  is 
often  an  an?emic  murmur.  The  muscles  waste 
quickly.  The  coffee  inebriate  is  always  thin. 
He  may  be  a  mere  skeleton  ;  his  eyes  are  bright 
and  quick  in  movement,  their  pupils  large  ;  and 
may  be  mistaken  for  a  tea-drinker.  In  the 
insomnia  which  follows,  when  the  coffee  is  re- 
moved, the  only  remedy  is  the  old  poison. 

"As  with  tea-drinking,  coffee  addiction  is 
followed  by  the  employment  of  spirits  and  other 
drugs.  Many  inebriates  and  opium-takers  have  a 
history  of  excessive  use  of  coffee  before  the  other 
drugs  were  taken.  The  recognition  of  addiction  to 
coffee  is  important  in  many  cases  of  neurotics, 
especially  in  children  and  young  persons,  and 
unless  promptly  checked  will  be  followed  by 
serious  results.  The  excessive  use  of  coffee  in 
all  cases  is  a  very  significant  hint  of  nerve- 
exhaustion  and  disorder  of  the  motor  nerves. 

"  In  the  late  war  many  cases  of  delirium  from 
coffee  were  noted  where  the  food-supply  was 
scant  and  coffee  was  abundant.     Some  of  these 


328  MODERN  TREATMENT  OF  ALCOHOLISM 

cases  came  under  special  treatment,  and  yielded 
readily  to  baths,  mineral  waters,  and  strong  foods. 
When  coffee  seems  first  to  have  been  used  for 
insomnia,  the  treatment  must  depend  on  a  careful 
study  of  the  etiology,  and  from  the  removal  of 
the  causes  the  cure  may  be  expected.  I  have  also 
noted  a  number  of  cases  in  young  children  of 
inebriate  and  neurotic  parents  who  developed  a 
morbid  impulse  for  coffee.  Such  cases  require 
active  treatment,  and  milk,  mineral  waters,  and 
baths  are  prominent  remedies.  Neurotic  disturb- 
ances and  diseases  from  coffee  are  but  little  known. 
**  Dr.  Mendel,  of  Berlin,  has  lately  published  a 
clinical  study  of  this  neurosis,  which  is  growing 
rapidly  in  this  country.  His  observations  w^ere 
confined  to  the  women  of  the  working  population 
in  and  about  Essen.  He  found  large  numbers 
of  women  consumed  over  a  pound  a  week,  and 
some  men  drank  considerably  more,  besides  beer 
and  wine.  The  leading  symptoms  were  profound 
depression  of  spirits,  and  frequent  headaches, 
with  insomnia.  A  strong  dose  of  coffee  would 
relieve  this  for  a  time,  then  it  would  return. 
The  muscles  would  become  weak  and  trembling, 
and  the  hands  would  tremble  when  at  rest.  An 
increasing  aversion  to  labour  and  any  steady 
work  was  noticeable.  The  heart's  action  was 
rapid,  irregular,  and  palpitations  and  a  heavy 
feeling  in  the  precordial  region  were  present. 
Dyspepsia  of  an  extreme  nervous  type  was  also 
present.      Acne    rosacea   was   common   in    these 


COFFEE  INEBRIETY  329 

cases.  These  symptoms  constantly  grow  worse, 
and  are  only  relieved  by  the  la.rge  quantities  of 
coffee,  generally  of  the  infusion.  In  some  cases  the 
tincture  was  used.  The  victims  suffer  so  seriously 
that  they  dare  not  abandon  it  for  fear  of  death. 

"  Where  brandy  is  taken  only  temporary  relief 
follows.  The  face  becomes  sallow,  and  the  hands 
and  feet  cold,  and  an  expression  of  dread  and 
agony  settles  over  the  countenance,  only  relieved 
by  using  strong  doses  of  coffee.  In  all  these  cases 
acute  inflammations  are  likely  to  appear  any 
time.  An  injury  of  any  part  of  the  body  is  the 
starting-point  for  inflammations  of  an  erysipela- 
tous character.  Melancholy  and  hysteria  are 
present  in  all  cases.  In  this  country  the  coffee- 
drinker  after  a  time  turns  to  alcohol  and  becomes 
a  constant  drinker.  In  other  cases  opium  is 
taken  as  a  substitute.  Coffee  inebriates  are  more 
common  among  the  neurasthenics,  and  are  more 
concealed,  because  the  effects  of  excessive  doses 
of  coffee  are  obscure  and  largely  unknown. 
Many  opium  and  alcoholic  cases  have  an  early 
history  of  excessive  use  of  coffee,  and  are  always 
more  degenerate  and  difficult  to  treat .  A  very  wide 
field  for  future  study  opens  up  in  this  direction. 

"  Dr.  Slayter  describes  a  case  of  delirium  in  a  girl 
who  chewed  large  quantities  of  tea.  It  appeared 
that  masses  of  tea  leaves  had  lodged  in  the  bowels, 
and  the  delirium  was  in  some  measure  dependent 
on  the  irritation  and  reflex  action  which  followed. 
Trembling,    delirium,    and    delusions    of    injury 


330  MODERN  TREATMENT  OF  ALCOHOLISM 

from  others,  gave  it  a  strong  resemblance  to 
delirium  tremens.  The  amount  of  tea  chewed 
daily  was  over  one  pound.  The  patient  recovered 
by  the  use  of  free  cathartics  and  the  withdrawal 
of  the  tea.  In  1881  I  saw  a  boy  who  had  delirium 
and  trembling  that  had  existed  at  intervals  for 
two  months.  The  fact  that  his  father  had  died 
an  inebriate  seemed  to  be  a  sufficient  reason  for 
his  symptoms  in  the  minds  of  his  friends.  It 
was  ascertained  that  he  had  for  years  drunk  large 
quantites  of  tea.  Having  been  employed  in  a 
tea-store,  he  had  chewed  it  freely.  He  was 
literally  a  tea  inebriate.  He  had  inherited  an 
inebriate  diathesis,  and  the  early  and  excessive 
use  of  tea  was  a  symptom  of  it.  He  had  all  the 
symptoms  of  one  who  was  using  alcohol  to  excess. 
He  recovered,  and  a  year  later  used  coffee  to 
great  excess,  until  he  became  uniit  for  work  ; 
then  was  under  medical  care  for  a  time,  recovered, 
and  finally  became  an  opium-taker. 

"Another  case  came  under  my  observation  in 
the  person  of  a  little  girl,  twelve  years  old,  the 
daughter  of  a  patient  under  my  care  for  inebriety. 
She  had  gradually  and  steadily  become  exces- 
sively nervous.  Could  not  sleep,  had  muscular 
twitchings  and  delusions  of  fear  ;  would  burst 
into  tears,  and  complain  that  she  was  going  to 
be  turned  out  into  the  streets.  She  heard  voices 
at  night,  and  could  not  keep  still.  She  also 
imagined  that  her  father  was  being  burned.  It 
was  finally  found  that  she  was  a  tea  inebriate, 


TEA  INEBRIETY  331 

and  both  drank  and  chewed  it  at  all  times  and 
without  any  restraint.  A  physician  consulted 
me  about  a  singular  stage  of  trembling  and  mild 
delusions  which  had  appeared  in  a  family  of  three 
old  maids  living  alone  in  the  country.  It  was 
found  to  come  from  excessive  use  of  tea,  and  to 
be  tea  inebriety.  When  this  was  stopped  they 
recovered.  My  observation  leads  me  to  think 
that  these  cases  are  not  uncommon  among  the 
neurotics.  They  are  of  such  a  mild  character 
at  first  as  to  escape  special  observation,  and 
hence  arc  supposed  to  be  due  to  other  causes. 
Such  cases,  after  beginning  on  tea,  take  other 
drugs,  and  become  alcohol,  opium,  or  chloral 
takers,  or  develop  some  form  of  neurosis,  which 
covers  the  real  and  first  causes. 

"  Theine  is  the  active  principle  of  the  leaves 
of  Chinese  tea,  and  is  generally  reputed  to  be 
identical  with  caffeine,  both  in  chemical  com- 
position and  in  physiological  action.  My  experi- 
ments show  that  it  differs  very  markedly  in 
physiological  action  from  that  of  caffeine.  Caffeine 
principally  affects  the  motor  nerves,  while  theine 
chiefly  influences  the  sensory  nerves,  and  chnicalh^ 
proves  itself  a  most  valuable  analgesic,  sui~passing 
morphia  in  promptness  and  permanency  in 
relieving  pain  in  some  affections,  without  pro- 
ducing any,  or  at  least  very  little,  disturbance 
of  the  general  nervous  system.  It  paralyses 
sensation  before  motion  ;  it  impairs  sensibility 
from  the  centre  to  the  periphery,  and  not,  like 


332  MODERN  TREATMENT  OF  ALCOHOLISM 

brucine  and  cocaine,  from  the  periphery  to  the 
centre  ;  it  produces  convulsions  which  are  spinal 
and  not  cerebral ;  it  has  a  more  powerful  action 
on  the  sensor}^  nerves,  and  less  on  the  motor 
nerves  than  caffeine. 

"  From  the  results  of  theine  in  these  cases  it  will 
be  seen  that  it  is  a  powerful  anodyne  without 
producing  am^  intoxication  of  the  higher  nerve 
centres,  which  is  so  common  with  morphia  and 
all  other  agents  belonging  to  this  class.  Its 
influence  is  both  quick  and  persistent,  and  it 
manifests  an  almost  exclusive  affinity  for  the 
sensory  nerves.  It  relieves  pain  by  acting  from 
the  centre  toward  the  periphery,  and  showing  its 
effects  but  very  seldom  above  the  seat  of  injection. 
In  i-io,  1-5,  and  even  ^  grain  doses  it  is  entirely 
free  from  dangerous  consequences — the  only 
inconvenience  which  it  causes  is  a  slight  but 
transient  burning  at  the  point  of  introduction.  I 
use  a  one  per  cent,  watery  solution  of  Merck's 
preparation — ten  minims  of  which  equal  one- 
fifth  of  a  grain  of  theine.  Larger  doses  are 
required  in  some  individuals  in  order  to  bring  out 
its  characteristic  action. 

"Effects  of  Tea  Drinking  on  the  Nutrition 
OF  THE  Eyeballs 

"  Dr.  Wolfe  has  described  the  first  effect  as  one 
of  softening  of  the  vitreous  humour,  which 
became  filled  with  floating  particles  of  pigment. 


TEA  INEBRIETY  333 

It  had  come  under  his  notice  in  persons  who  at 
first  sight  seemed  to  have  very  Httle  in  common. 
He  had  found  it  among — i.  The  mining  popula- 
tion, who  pass  a  deal  of  time  underground. 
2.  Washerwomen.  3.  Middle-aged  labourers, 
masons,  and  outdoor  workers.  4.  Shop  and 
factory  girls.  5.  Not  a  few  belonging  to  the 
upper  classes.  His  attention  was  specially 
directed  to  the  affection  by  its  frequent  occur- 
rence among  Australians  who  came  to  consult 
him.  He  could  discover  no  assignable  cause 
for  the  disease,  either  in  the  tissues  themselves 
or  in  the  history  of  the  patient  ;  and  it  was  only 
on  directing  his  inquiries  to  their  diet,  and  finding 
that  they  all  agreed  in  consuming  large  quantities 
of  tea,  that  he  came  to  suspect  its  agency.  A 
comparison  of  the  numerous  cases  of  opacity 
of  the  vitreous  humour  occurring  among  tea-drink- 
ing populations,  with  its  less  frequency  in  France, 
Germany,  and  America,  and  its  rarity  among  the 
Turks,  tended  to  confirm  his  suspicions.  Physi- 
ology did  not  suggest  an  explanation,  but 
chemistry  pointed  to  theine  and  tannic  acid  as 
most  likely  to  cause  disease.  Theine  might  be 
left  out  of  consideration,  being  identical  with 
caffeine,  which  was  innocuous  ;  so  there  only 
remained  tannic  acid.  This  precipitated  albu- 
minoids from  their  solutions  ;  hence  it  probably 
acted  injuriously  by  precipitating  some  of  the  most 
important  constituents  of  the  food,  and  also  by 
affecting  the  mucous  membrane  of  the  stomach 


334    MODERN  TREATMENT  OF  ALCOHOLISM 

and     alimentary     canal,     and     thus    preventing 
digestion  and  assimilation. 

"Some  observations  had  been  made  as  to  the 
effects  of  tea-drinking  on  the  healing  of  wounds 
and  ulcers,  by  a  Glasgow  surgeon,  who  had 
noticed  that,  in  persons  addicted  to  this  habit, 
they  took  on  a  sort  of  scorbutic  character. 
Physicians  also  ascribed  numerous  cases  of 
rebeUious  dyspepsia  to  the  use  of  tea.  The 
disease  of  the  vitreous  humour,  above  alluded  to, 
could  hardly  be  an  isolated  pathological  fact,  but 
must  be  associated  with  deleterious  changes  in 
other  parts  of  the  economy,  and  probably  only 
made  its  appearance  in  organs  which  had  a 
predisposition  to  be  so  affected.  Without  ventur- 
ing upon  any  theory  as  to  the  action  of  tea  on 
the  vitreous  humour,  he  would  point  out  that 
the  first  expression  of  acute  irritation  of  the  fifth 
nerve  in  sympathetic  ophthalmia  was  opacity  of 
the  vitreous  humour  and  detachment  of  pigment 
from  the  whole  uvular  tract.  So  it  was  possible 
that  chronic  irritation  of  the  same  nerve  might 
give  rise  to  such  changes  in  the  nutrition  of  the 
eyeball  as  to  bring  about  the  condition  under 
consideration.  He  commended  this  subject  to 
the  notice  of  general  practitioners,  who  had  better 
opportunities  of  judging  of  it  than  he  had." 

Treatment  of  the  Opium  Habit 

The  American  Association  for  the  Study  and 
Cure  of  Inebriety  gives  details  of  two  methods 


OPIUM  INEBRIETY  335 

for  the  treatment  of  the  Opium  habit.  One  of 
these  is  credited  to  Dr.  Jennings  of  Paris,  and  is 
based  on  the  principle  of  cardiac  stimulation, 
while  the  other  (Dr.  Mathison's)  is  of  an  entirely 
opposite  nature,  being  essentially  a  bromide 
treatment.  They  are  contained  in  the  following 
quotation  from  their  well-known  publication, 
The  Disease  of  Inebriety  : — 

**  In  the  special  treatment  : — i.  We  have  to 
deal  with  an  individual  whose  will-power  is 
subverted.  To  him  the  enslaving  drug  has 
become  as  much  a  necessity  of  existence  .-.b  his 
food  and  drink.  Any  treatment  which  depends 
upon  his  own  volition  must  fail.  For  his  own 
must  be  substituted  the  control  of  another  sound 
will.  As  a  rule,  removal  from  home  is  essential  to 
secure  this  control.  As  in  insanity  and  hysteria, 
strangers  have  far  more  control  than  relatives 
or  friends.  It  has  the  further  advantage  of 
breaking  up  the  train  of  associations,  which  is 
always  a  great  aid  in  overcoming  a  confirmed 
habit.  Special  asylums  have  their  advantages 
(if  under  proper  management)  and  their  dis- 
advantages.    I  shall  not  discuss  this  point. 

"  The  choice  of  attendant  is  of  great  importance, 
as  upon  his  or  her  trustworthiness  and  efficiency 
the  result  may  often  depend.  In  the  case  re- 
ported, the  firmness  and  tact  of  the  nurse,  her 
readiness  with  massage,  bath,  medicine,  or 
nourishment,  etc.,  enabled  the  reduction  to  be 


336   MODERN  TREATMENT  OF  ALCOHOLISM 

made  rapidly,  and  assisted  greatly  in  mitigating 
the  prostration  and  suffering  of  the  patient.  With 
inflexible  will  she  combined  a  patience  and  sym- 
pathy  which  made  the  patient  feel  she  was  a 
strong  friend  to  help,  not  a  jailer  or  detective,  and 
was  thus  a  model  of  what  is  needed  in  the 
attendant. 

"2.  Control  of  the  patient  having  been  secured, 
how  shall  the  drug  be  taken  from  him  ?  Three 
methods  have  their  advocates  :  {a)  immediate 
and  entire  withdrawal  ;  (b)  gradual  reduction  ; 
(c)  rapid  reduction. 

"  Under  the  first  the  sufferings  are  intolerable, 
the  prostration  great  and  dangerous,  and  it  does 
not  offer  any  great  security  against  relapse. 

"  In  the  majority  of  instances  the  rapid  reduction 
is  the  wiser  means  between  the  two  extremes. 
The  rapidity  should  var}^  with  the  case,  and  should 
be  such  as  not  to  involve  extreme  suffering  or 
great  prostration. 

"3.  We  have  to  deal  in  all  cases  of  long  standing 
with  an  emaciated  body  and  starving  nerve 
centres.  At  the  same  time  we  have  complete 
anorexia  and  feeble  digestion,  perhaps  nausea 
and  vomiting.  The  feeding  of  the  patient 
becomes,  therefore,  one  of  the  most  important, 
and  perhaps  most  difficult  parts  of  the  treatment. 

"Often  it  is  well  to  begin  with  exclusive  milk 
diet  (peptonised,  if  necessary).  Systematic  feed- 
ing of  small  quantities  at  regular  intervals  is 
usually  best.     Confinement  to  bed  during  early 


OPIUM  INEBRIETY  337 

part  of  treatment  will  promote  the  mitrition.  At 
the  same  time  it  reduces  to  the  minimum  the  tax 
upon  the  shattered  nervous  system.  For  the 
same  reason,  as  well  as  for  the  sake  of  preventing 
the  clandestine  supply  of  the  drug,  seclusion  is 
best  until  convalescence  is  well  established. 

"  The  good  results  of  the  *  rest  treatment,'  as 
advocated  by  Mitchell,  i.e.,  seclusion,  confinement 
to  bed,  forced  feeding,  massage,  and  electricity, 
with  gradual  (usually  rapid)  reduction  of  the 
drug,  are  permanent. 

"  4.  The  use  of  the  various  mechanical  agencies 
for  the  relief  of  pain,  quieting  the  nervous  system, 
inducing  sleep  and  promoting  nutrition — massage 
electricity  (both  faradism  and  galvanism),  hot 
baths,  Turkish  baths,  the  cold  shower-bath.  Dr. 
Jennings  recommends  the  hammock  for  the 
restlessness  and  desire  for  constant  motion,  so 
often  a  distressing  symptom. 

"5.  Medicinal  agents  to  meet  the  various  in- 
dications of  each  case." 

The  observations  of  Drs.  Jennings  and  Ball,  of 
Paris,  upon  the  sphygmographic  tracings  of  the 
pulse  of  habitues,  we  believe,  have  laid  the  physio- 
logical basis  for  a  rational  system  of  medication. 

These  observations,  which  have  been  confirmed 
by  others,  show  "  that  the  pulse  of  a  morphine 
habitue  in  a  state  of  privation  .  .  .  caused  by 
want    of    cardiac    impulsion,    together    with    a 


338  MODERN  TREATMENT  OF  ALCOHOLISM 

resistance  to  the  passage  of  the  blood  in  the 
vessels.  A  hypodermic  or  morphia  given  at  this 
moment  restores  the  normal  state  of  the  circula- 
tion. The  study  of  these  tracings  suggested  the 
use  of  cardmc  tonics  and  stimulants  as  substi- 
tutes for  the  morphia  during  the  progressive 
reduction."  The  drugs  chosen  were  :  "Sparteine, 
on  account  of  the  facihties  it  offers  for  hypodermic 
injection,  and  producing  thus  a  rapid  and  evident 
effect  ;     and   trinitin,   because   of  its  congestive 

j  effect  on  the  head  and  its  calorific  effect  upon  the 

Ibody  generally." 

j  Dr.  Jennings  uses  these  remedies  in  the  gradual 
suppression  of  the  drug  when  the  reduction  has 
reached  such  a  degree  as  to  bring  on  the  symptoms 
of  deprivation.  It  is  not  to  be  understood  that 
these  drugs  take  the  place  of  morphia,  i.e.  that 
it  can  be  at  once  omitted  without  the  usual 
suffering  ;  they  are  but  aids  in  mitigating  that 
suffering  by  counteracting  some  of  the  circulatory 
disturbances  upon  which  it  largely  depends. 

The  evidence  of  clinical  experience  is  largely 
in  favour  of  heart  tonics  and  stimulants  rather 
than  sedatives.  In  the  case  reported,  no  sedatives 
were  given,  yet  after  the  first  few  nights,  sleep 
was  good.  The  glonoin  had  certainly  a  good 
effect,  being  given  at  the  time  when  the  symptoms 
of  the  craving  came  on,     Quinia  was  used  as  a 


OPIUM  INEBRIETY  339 

stimulant  to  the  heart  and  the  cerebral  circula- 
tion. Strychnia  was  given  as  a  heart  tonic  after 
complete  withdrawal  of  morphia. 

When  nervousness  is  great,  or  insomnia  does 
not  yield  to  other  means,  drugs  may  be  necessary. 
In  these  instances,  cannabis  indica  in  large  doses 
(I  to  I  drachm  of  fi.  ext.),  sulphonal,  chloralamid  or 
bromides  will  often  render  good  service.  Chloral 
is  used  by  Erlenmeyer,  condemned  by  Aurleck 
and  others.  Dr.  Jennings  seems  latterly  to  have 
usually  substituted  digitalis  per  os  for  spatrein 
hypodermatically.  Quinia  has  seemed  to  me 
in  many  cases  of  distinct  value.  Strychnia  is 
one  of  the  best  heart  tonics  in  the  pharmacopoeia.. 

Obersteiner  is  almost  the  only  writer  of  note 
who  now  speaks  well  of  cocaine.  If  used  at  all,/ 
it  should  never,  of  course,  be  placed  in  the  hands 
of  the  patient  himself.  The  fluid  extract  of  coca 
has  been  highly  spoken  of  by  several  writers  tq 
relieve  restlessness  and  depression.  Valerianate! 
of  ammonia  has  been  a  common  favourite  since^, 
the  time  of  De  Quincey. 

This  method,  which,  so  far  as  we  are  aware,  is 
original  with  and  peculiar  to  Dr.  Mathison,  is 
merely  a  new  application  of  a  well-estabhshed 
principle,  for  the  power  of  the  bromides  to  sub- 
due abnormal  reflex  irritability  is  so  constant 
that  it  may  be   looked   upon  as   an   invariable 


340  MODERN  TREATMENT  OF  ALCOHOLISM 

sequel  of  such  medication.  Dr.  Ed.  H.  Clarke, 
in  his  valuable  treatise  on  the  bromides,  says  : 
"  Diminished  reflex  sensibility,  however  different 
physiologists  may  explain  the  fact,  is  one  of  the 
most  frequent  phenomena  of  bromidal  medication 
that  has  been  clinically  observed,  and  is,  thera- 
peutically, one  of-  the  most  important."  The 
testimony  of  other' distinguished  observers  is  to 
the  same  effect — Cubler,  Guttman,  Laborde, 
Voison,  Damourette,  Eulenberg,  Claude  Bernard, 
Brown-Sequard,  Echeverria,  and  Hammond  all 
giving  evidence  as  to  the  power  of  these  agents  to 
impair  the  control  of  the  spinal  cord  over  reflex 
manifestations,  and,  at  the  same  time,  exert  a 
marked  influence  over  the  general  nervous 
system.  Admitting  that  the  symptomatology  of 
opiate  abandonment  pertains  almost  exclusively 
to  the  functions  over  which  the  bromides  exert 
so  decided  a  control,  we  have  in  the  treatment 
of  opium  inebriety  a  new  field  presented  for  the 
exercise  of  this  valuable  property ;  and  the  fact, 
proven  conclusively  by  our  experience  that  it 
does  exert  this  happy  effect,  fully  supports  the 
idea  advanced  as  to  the  pathology  of  this  disease. 
In  speaking  of  the  bromide  of  sodium,  let  it  be 
understood  that  we  refer  entirely  to  the  influence 
of  the  continued  dose,  by  which  we  mean  its 
administration   throe    times   in   the   twenty-four 


OPIUM  INEBRIETY  341 

hours,  at  regular  intervals,  so  as  to  keep  the 
blood  constantly  charged  with  the  drug.  A 
most  important  difference,  physiological  and 
therapeutical,  exists  between  the  effect  of  this 
mode  of  exhibition  and  that  of  the  single  dose,  or 
two  or  three  doses  so  nearly  together  as  to  form 
practically  one,  for  in  the  former  case  the  system 
is  constantly  under  the  bromide  influence,  while 
in  the  other  the  drug,  being  largely  eliminated  in 
a  few  hours,  the  blood  is  nearly  free  from  it  a 
large  portion  of  the  time.  Results  obtainable 
from  the  continued  use  cannot  be  gotten  from  the 
single  dose,  and,  as  a  consequence,  its  value  is 
far  greater  in  the  disease  under  consideration. 

Again,  the  action  of  the  continued  dose  being 
somewhat  remote,  three  to  five  days  usually 
elapsing  before  there  is  decided  evidence  in  this 
direction,  much  more  desirable  results  are  secured 
by  its  employment  for  several  days  prior  to  an 
entire  opium  abandonment,  meanwhile  gradually 
reducing  the  opiate,  than  if  the  withdrawal  be 
complete,  and  then  reliance  placed  on  the  bromide 
to  control  the  resultant  irritability  ;  for  in  one 
instance  the  maximum  sedative  effect  is  reached 
at  the  period  of  maximum  disturbance  from 
the  opium  removal,  and  its  counteracting  and 
controlling  effect  is  far  in  excess  of  that  to 
be  had  from  its  employment  subsequent  to  the 


342  MODERN  TREATMENT  OF  ALCOHOLISM 

lighting  up  of  the  nervous  irritation.  What, 
then,  we  style  preliminary  sedation  forms  a 
peculiar  and  most  valuable  feature  in  our  adminis- 
tration of  the  bromide,  and  it  is  this  particular 
point  we  commend  to  you,  our  experience  having 
convinced  us  we  have  in  it  unequalled  means  of 
obviating  the  suffering  incident  to  the  treatment 
of  this  disorder. 

The  value  of  the  various  bromides  depends  on 
their  proportion  of  bromine.  Bromide  of  potas- 
sium contains  66  per  cent.,  sodium  78,  and 
lithium  92  per  cent.  We  should,  therefore, 
expect  a  more  powerful  influence  from  the  latter 
agent ;  and,  according  to  Wier  Mitchell,  it  has  a 
more  rapid  and  intense  effect.  Bromide  of  sodium 
being  richer  in  bromine,  and  pleasanter  to  the 
taste,  we  prefer  it  to  potassium. 

Either  of  the  bromides,  in  powder  or  concen- 
trated solution,  is  somewhat  irritant,  sometimes 
provoking  emesis,  and  in  any  event  delaying  its 
absorption.  A  practical  point,  then,  is  that 
it  be  given  largely  diluted.  Dr.  Clarke  says, 
"  There  should  be  at  least  a  drachm  of  water 
to  each  grain  of  the  salt."  We  give  each 
dose  of  the  sodium  in  six  or  eight  ounces  of 
cold  water,  and  have  never  known  it  to  cause 
vomiting. 

Another  important  feature  relates  to  the  time 


OPIUM  INEBRIETY  343 

of  its  employment.  We  usually  administer  it 
at  10  a.m.,  4  and  10  p.m.,  or  half  an  hour 
before  each  meal.  Given  thus,  largely  diluted, 
it  is  probably  absorbed  in  half  an  hour,  and 
the  effect  of  the  continued  dose  rapidly 
secured. 

To  produce  the  requisite  degree  of  sedation 
within  a  limited  period,  it  is  essential  that  the 
bromide  be  given  in  full  doses.  I  am  convinced 
that  failure  in  its  use,  in  any  neurosis,  is  very 
often  due  to  a  non-observance  of  this  point. 
Our  initial  dose  of  the  sodium  is  30  grs.  twice 
daily,  time  and  mode  as  stated,  increasing  the 
daily  amount  30  grs.  each  day,  i.e.  40,  50, 
60  grs.  and  continuing  it  eight  days,  reaching 
a  maximum  dose  of  100  grs.  twice  in  the 
twenty-four  hours.  This  period  may  last  a 
week  or  more,  depending  on  some  state  of  the 
blood  and  power  of  elimination.  During  this 
week  of  bromidal  medication,  the  usual  opiate 
is  gradually  reduced,  so  that  on  the  seventh  or 
eighth  day  it  is  entirely  abandoned.  A  decrease 
of  one-third  or  one-half  the  accustomed  daily 
quantity  is  made  at  the  outset,  experience  having 
shown  that  habitues  are  almost  always  using 
an  amount  in  excess  of  their  actual  need,  and 
this  decided  reduction  occasions  little  or  no 
inconvenience.     Subsequently,   the   opiate   with- 


344  MODERN  TREATMENT  OF  ALCOHOLISM 

drawal  is  more  or  less  rapid  according  to  the 
increasing  sedation,  the  object  being  to  meet  and 
overcome  the  rising  nervous  disturbance  by 
the  growing  effect  of  the  sedative — in  other 
words,  maximum  sedation  at  the  time  of  maxi- 
mum irritation. 

Having  secured  the  sedative  effect  desired, 
the  object  is  to  ehminate  the  bromide  as  rapidly 
as  possible ;  and  as  the  skin  and  kidneys  form 
the  only  outlets,  recourse  is  had  at  once  to 
diaphoretics  and  diuretics.  Of  the  former,  hot 
and  steam  baths  are  to  be  relied  upon.  And, 
of  the  latter,  digitalis,  in  effusion,  or,  if  bulk  be 
objectionable,  Squibb's  fluid  extract  combined 
wdth  potass,  acet.  and  spirits  sether  nitrosi. 
The  bromide  itself  increases  renal  secretion,  and, 
aided  by  the  others,  it  passes  from  the  system 
in  a  few  days.  The  bromide  and  opiate  having 
been  discontinued,  restlessness,  more  or  less 
prominent,  from  twenty  to  fifty-six  hours,  in- 
variably supervenes.  It  is  controlled  by  codeine, 
I  to  3  grs.  subcutaneously,  or  by  mouth,  every 
two  to  four  hours ;  and  this  is  continued, 
decreasing  the  dose  or  increasing  the  interval 
till  no  longer  needed,  but  is  greatly  relieved 
by  hot  —  not  warm  —  baths,  temperature  iio° 
to  112°,  fifteen  to  thirty  minutes'  duration, 
repeated   as  required.     They  are   often   signally 


OPIUM  INEBRIETY  345 

effective.  We  have  known  a  patient  fall  asleep, 
snoring  vigorously,  while  in  a  bath. 

Sleeplessness  is  always  more  or  less  prominent 
after  opium  abandonment.  During  the  first  six 
nights,  sulfanol  or  trianol  in  30  or  40  gr.  doses 
is  given.  Afterward,  such  hypnotic  as  seems 
best  suited  to  the  case  ;  chloral  is  most  effective 
in  20  or  30  gr.  doses  at  bedtime.  Often  smaller 
doses  may  be  given  at  intervals  of  two  hours 
until  sleep  follows,  with  good  results. 

A  peculiarity  of  this  insomnia  is,  that  it  is 
most  marked  in  the  early  morning.  Slumber 
comes  readily  enough  at  night,  but  patient 
awakes  at  two,  three,  or  four  o'clock,  and  finds 
further  sleep  impossible.  Often  it  is  well  to 
defer  the  sleeping  draught  until  this  time.  This 
waking  tendency  gradually  diminishes,  and 
ultimately  disappears. 

Chloral  given  during  the  early  opium  abstin- 
ence has,  with  us,  not  acted  kindly  as  a  hypnotic, 
but  produced  a  peculiar  intoxication,  though  we 
have  never  noted  the  wild,  maniacal  delirium  men- 
tioned by  Dr.  Levenstein  as  occurring  during  this 
period  in  his  cases.  As  soon  as  possible  it  should 
be  discontinued,  and  sleep  secured  by  a  fatiguing 
walk,  a  half-hour's  warm  bath,  a  light  lunch  or 
glass  of  milk — one  or  all,  before  retiring. 

For  three  or   four   days  following  the  opiate 


346  MODERN  TREATMENT  OF  ALCOHOLISM 

withdrawal  the  diet  should  be  exclusively  of 
milk  combined  with  lime-water — one  or  two 
ounces,  with  one  or  two  drachms  respectively — 
every  hour  or  two.  It  is  very  seldom  rejected, 
and  is  preferable  to  beef  tea  or  anything  else. 
Afterwards,  a  full,  solid  diet  may  be  resumed, 
soon  as  practicable. 

While  diarrhoea  is  the  decided  exception  under 
this  plan  of  treatment,  we  still  deem  it  best  to 
keep  the  bowels  in  good  condition,  and  administer 
the  first  night  a  mercurial  cathartic  sufficient 
for  several  full  evacuations,  followed  during  the 
bromide  giving  by  daily  laxative  enemas,  or 
doses  of  Hunyadi  water. 

Debility  of  varying  degree,  due  to  the  opium 
abstinence  and  bromide  relaxation,  is  among 
the  sequelae.  It  decreases  with  the  increasing 
bromide  elimination,  aided  most  effectively  by 
general  faradisation,  twenty  minutes  morning 
seances  daily,  after  the  restlessness  subsides, 
and  strychnia  ^V  gr.  thrice  daily,  combined 
with  iron,  quinine,  phosphorus,  digitalis,  or 
cod-liver  oil,  as  most  required. 

The  following  formula  are  valuable  : 

IJL  Strychnine,  2  grs.  ;  muriated  tinct.  iron, 
5  oz. ;  tinct.  digitalis  and  glycerine,  of  each  2h  oz. 
M.  Dose  —  One  to  two  drachms  three  times 
daily. 


OPIUM  INEBRIETY  347 

IjL  Strychnine,  .  4  grs.  ;  dialised  iron,  5  oz. 
M.     Dose — One-half  drachm  three  times  daily. 

1^  Strychnine,  2  grs.  ;  dilute  phosphoric  acid 
and  syrup  of  ginger,  of  each  2 J  oz.  M.  Dose — 
One  drachm  thrice  daily. 

I^  Pyrophosphate  or  iron,  5  to  10  grs. ; 
quinine,  2  grs.  at  a  dose.  M.  Pill,  or  solution, 
three  times  a  day,  if  the  appetite  be  slow  in  re- 
turning. 

1^  Comp.  tinct.  quassia,  one  drachm ;  tinct. 
capsicum,  10  drops.  M.  For  one  dose,  diluted, 
twenty  minutes  before  each  meal. 

Strychnine  is  not  advisable  during  the  bromide 
administration.  Being  decidedly  antagonistic, — 
one  causing  relaxation  and  deficient  reflex  ex- 
citability, the  other  just  the  reverse, — the  desired 
sedative  effect  may  be  materially  delayed  if  they 
be  given  together.  Subsequently,  it  is  the  most 
valued  general  tonic  at  command,  and  may  be 
continued  in  varied  combination  for  weeks. 
With  the  strictly  medicinal  course  are  to  be  em- 
ployed a  full  nutritious  diet,  out-of-door  exercise, 
especially  walking,  and  varied  social  enjoyments — 
in  fact,  anything  that  can  exert  a  roborant  effect 
on  mind  or  body. 

Surprise     may    be     expressed    and    objection 


348  MODERN  TREATMENT  OF  ALCOHOLISM 

made  regarding  the  extent  of  the  bromide  doses, 
but  the  fact  must  never  be  overlooked  that  we 
are  not  to  be  governed  in  the  giving  of  any  remedy- 
by  the  mere  numerical  amount  of  drops  or  grains, 
but  by  the  effect  produced.  Again,  I  am  led  to 
think  that  one  effect  of  opium  addiction  is  a 
peculiar  non-susceptibility  to  the  action  of 
various  nervines,  necessitating  their  more  robust 
exhibition  to  secure  a  decided  result.  More, 
and  most  important  of  all,  under  the  influence 
of  certain  abnormal  conditions,  doses  which 
ordinarily  are  toxic  become  simply  therapeutic. 
The  annals  of  medical  literature  abound  with 
illustrations  in  support  of  this  statement,  and 
among  the  most  striking  may  be  noted  the 
following  : — Dr.  Southey  read  before  the  Clinical 
Society  of  London  notes  of  a  case  of  idiopathic 
tetanus  which  occurred  in  a  boy  ten  years  old. 
The  first  symptoms  of  trismus  were  observed 
two  days  after  a  severe  fright  and  drenching 
due  to  the  upset  of  a  water-butt.  They  steadily 
increased  up  to  the  date  of  his  admission  to  St. 
Bartholomew's  Hospital,  upon  the  eighth  day  of 
his  illness,  when  the  paroxysms  of  general  opistho- 
tonos seized  him  at  intervals  of  nearly  every  three 
minutes.  Each  attack  lasted  from  fifteen  to 
thirty  seconds ;  and  although  between  the  seizures 
the  muscles  of  the  trunk  became  less  rigid,  those 


OPIUM  INEBRIETY 


349 


of  the  neck  and  jaw  were  maintained  in  constant 
tonic  cramp.  Tlie  patient  was  treated  at  first 
with  chloral,  lo  grs.,  and  bromide  of  potassium, 
20  grs.,  every  two  hours,  and  afterwards  with 
the  bromide  alone  in  6o-grain  doses  every  hour 
and  a  half.  When  about  two  ounces  were 
taken  in  the  twenty-four  hours,  the  attacks  be- 
came less  frequent ;  but  at  first  each  separate 
seizure  was  rather  more  severe,  and  upon  the 
evening  of  the  eleventh  day  he  was  able  to  open 
his  mouth  better. 

On  the  thirteenth  day  the  bromide  was 
decreased  to  20  grs.  every  three  hours,  and 
on  the  fourteenth  day  was  discontinued  alto- 
gether. When  the  bromide  had  been  omitted 
for  twenty-four  hours,  the  attacks  returned 
at  intervals  of  an  hour,  and  the  permanent 
rigidity  of  the  muscles  of  the  neck  was  re-estab- 
lished. His  condition  now  steadily  became  worse, 
so  that  on  the  eighteenth  day  of  his  illness  it 
became  necessary  to  resort  to  the  previous  large 
doses — one  drachm — every  hour  and  a  half. 
After  three  such  doses  the  expression  became 
more  natural,  and  he  was  able  to  open  his  mouth 
again  ;  but  it  was  not  till  the  twenty-fifth  day 
of  the  disease  that  it  was  possible  to  discontinue 
the  remedy.  The  patient  remained  in  a  state  of 
remarkable  prostration  and  drowsiness,  sleeping 


350  MODERN  TREATMENT  OF  ALCOHOLISM 

twenty-four  hours  round,  and  only  waking  up 
to  take  his  nourishment  for  eight  days,  and  passed 
all  his  evacuations  under  him.  He  subsequently 
steadily  and  rapidly  convalesced.  The  bromide 
produced  no  acne  or  other  disagreeable  s^^mptoms, 
and  certainly  appeared  to  exert  marked  in- 
hibitory influence  upon  the  tetanus. 

Surely,  under  ordinary  circumstances,  no  one 
would  think  of  giving  such  extensive  doses  of 
the  bromide;  but  here,  under  the  antagonising 
influence  of  the  intense  reflex  irritability,  their 
effect  was  vastly  beneficial,  conducing,  unques- 
tionably, to  the  patient's  cure. 

Given  as  we  recommend,  no  effect  is  usually 
produced  by  the  bromide  before  the  third  day. 
From  the  third  to  the  fifth,  an  unpleasant  taste 
is  complained  of ;  the  bromic  breath  begins  ; 
the  patient  is  disposed  to  drowse,  and  there  is 
a  growing  indisposition  to  muscular  exertion. 
From  the  fifth  to  the  seventh  these  symptoms 
increase — the  tongue  begins  to  fur  ;  the  odorous 
breath  is  marked  ;  the  drowsiness  deepens  into 
sound  sleep,  more  or  less  prolonged,  and  the 
inaptitude  for  physical  exercise  becomes  so 
decided  that  patients  generally  take  to  bed  on 
the  last  day.  The  following  two  or  three  days — 
during  the  period  of  maximum  disturbance 
from   the   opium   withdrawal — are   characterised 


OPIUM  INEBRIETY  351 

by  a  persistence  of  the  symptoms  alluded  to. 
Patient  remains,  more  or  less  restlessly,  in  bed. 
General  relaxation  is  decided  ;  the  pulse  is 
less  frequent — usually  about  60  ;  the  voice 
somewhat  weakens ;  pupils  dilated  ;  the  renal 
secretion  augmented — though,  sometimes,  dimin- 
ished ;  the  saliva  increased  and  rather  viscid, 
and  mild  hallucinations  of  sight  and  sound 
— almost  always  of  sight — occur,  occasionally, 
for  three  or  four  days,  accompanied  with  a 
peculiar  aphasic  tendency,  as  shown  by  sub- 
stituting one  word  for  another — Mediterranean 
for  Mississippi ;  Brown  instead  of  Iowa,  etc. 
This  curious  symptom  may  occur  at  increasing 
intervals  for  several  days. 

Dr.  Clarke  refers  to  such  instances.  He  says  : 
"  They  are  hints  of  a  distinct  organ  of  language, 
and  suggest  the  notion  that,  inasmuch  as  the 
drug  we  are  considering  paralyses  reflex,  before 
it  does  general  sensibility,  language  may  be  the 
expression  or  correlation  of  a  peculiar  reflex 
power." 

After  the  ninth  or  tenth  day  the  bromidial 
manifestations  gradually  disappear,  so  that 
within  two  weeks  from  beginning  of  treatment, 
patient  is  generally  up,  and  the  only  prominent 
symptoms  remaining  are  the  debility  and  in- 
somnia.    Tonics,  hypnotics,   and  vis  medicatrix 


352  MODERN  TREATMENT  OF  ALCOHOLISM 

naturae  effect  speedy  convalescence,  and — where 
treatment  is  begun  on  entrance — patients  are 
usually  dismissed,  cured,  within  a  month. 

More  than  one  week's  employment  of  the 
sodium  is  not  advisable,  lest  the  hallucinations 
become  unpleasantly  persistent ;  and  cases  will 
present  in  which  a  minor  degree  of  administra- 
tion— five  or  six  days — wall  suffice. 

Marked  general  debility  contra-indicate  the 
bromide,  and  a  tonic  course  should  precede  it. 

Granted  a  case  suitable  for  treatment,  this 
method  may  be  summarised  as  follows  : — Opiate 
reduced,  at  once,  to  one-half  or  two-thirds  usual 
quantity.  Subsequent  gradual  decrease  and 
entire  withdrawal  in  seven  or  eight  days.  Mer- 
curial cathartic,  first  night,  followed  by  daily 
laxative  enemas,  or  Hunyadi  water.  Bromide 
of  sodium,  30-grain  doses,  increased  thirty  grains 
daily,  in  six  or  eight  ounces  water,  on  empty 
stomach,  continued  five  to  seven  days.  Restless- 
ness following  opium  abandonment  met  by  hot 
baths,  100°  to  110°,  ten  to  thirty  minutes 
each,  often  as  required.  Bromide  eliminated  by 
diuretics — digitalis  and  nitre,  and  diaphoretics — 
hot  and  steam  baths.  Insomnia  relieved  by 
chloral,  combined,  if  need  be,  with  Indian  hemp 
or  hyoscyamus.  Diet  exclusively  milk  and  lime- 
water — first    three    days    of    opium    abstinence. 


OPIUM  INEBRIETY  353 

Full  diet  resumed  as  soon  as  possible.  Debility 
removed  by  generous  living,  general  faradisation, 
strychnine,  iron,  quinine,  etc.,  with  out-of-door 
exercise  and  varied  social  enjoyment. 

For  relief  of  neuralgic  pain,  varied  measures 
suffice.  Leading  the  list  are  electricity  and  the 
local  use  of  ether.  As  to  the  value  of  the  gal- 
vanic current  in  migraine  and  other  neuralgias, 
so  common  in  opium  habitues,  and  the  manner  of 
using  it,  the  reader  is  referred  to  papers  by  the 
writer.  The  same  agent  is  effective  in  relieving 
limb  and  lumbar  pains,  though  here  a  much 
stronger  current  is  required  than  can  be  used  with 
safety  about  the  head.  Sometimes  a  faradic 
current  acts  well ;  and  when  one  fails,  trial  should 
always  be  made  with  the  other.  Local  hot 
baths  are  often  of  great  service. 

Regarding  the  ether,  those  who  have  never  used 
it  will,  we  think,  be  surprised  at  its  pain-easing 
power.  In  either  way  applied — spra}-,  drop  or 
lavement — it  is  potent  for  good. 

These  three — electricity,  ether,  hot  water — are 
valued  anodynes,  and  one  special  point  in  their 
favour  is  entire  freedom  from  unpleasant  gastric 
or  other  result. 

Other  remedies  relieve,  at  times  ;  of  the  coal-tar 
salts,   phenacetine,    or   phenocoll,    10   to    15   gr. 
doses  are  best.     It  has  often  a  hypnotic  effect. 
23 


354     MODERN  TREATMENT  OF  ALCOHOLISM 

A  valued  external  anodyne  is :  menthol,  i  part ; 
chloroform,  lo  parts  ;  ether,  15  parts, — used  as 
spray. 

Under  this  plan  of  treatment  marked  disorder 
of  stomach  or  bowels  is  rare.  Our  rule  is  to 
give  a  mercurial  or  other  cathartic  at  the  outset,  if 
there  be  alvine  torpor,  and  then  secure  regular 
action  by  such  laxative  as  seems  best.  If  re- 
straint be  needed,  large  enemas  of  hot  water 
may  be  used.  This  failing,  i  to  3  grs.  sulpho- 
carbolate  of  zinc,  10  to  20  minim  doses  of  fluid 
extract  of  coto,  in  capsules,  or  40  to  60  grs.  of 
subnitrate  of  bismuth  every  four  hours.  If, 
however,  it  persists,  the  best  thing  is  a  full 
opiate — tinct.  opii,  per  mouth  or  rectum,  at 
bedtime  preferred.  This  promptly  controls, 
gives  a  full  night's  sleep,  and  the  trouble  seldom 
returns.  Fear  of  a  bad  effect  on  convalescence  is 
unfounded. 

Diet  is  not  restricted,  unless  the  condition  of 
stomach  or  bowels  demands.  We  have  again 
and  again  seen  patients  recover  who  did  not 
vomit  once,  or  who  had  only  two,  three,  or  four 
movements  daily.  The  excessive  vomiting 
mentioned  by  Levenstein  and  Obersteiner — 
abrupt  disuse  —  we  have  never  noted.  The 
former  thought  the  collapse — which  we  have 
never  seen — in  several  of  his  cases  was  due  to 


OPIUM  INEBRIETY  355 

vomiting  and  purging.  More  likely  the  largest 
factor  in  causing  it  was  the  exhausting  mental  and 
physical  suffering  which  his  method  entails.  If 
the  stomach  rebels,  entire  rest  for  a  time,  or  milk 
and  lime-water,  ale  and  beef,  malted  milk  or 
bovinine,  in  small  amount,  may  act  well.  If  not, 
sinapisms,  ether,  faradism,  or  chloroform,  alcohol 
and  ice  are  of  value.  All  failing,  a  full  opiate 
hypodermic  will  promptly  suffice. 

Twenty-four  hours  after  the  opiate-quitting, 
patients  are  directed  to  bed,  and  kept  there  two 
to  four  days,  for  we  are  convinced  that  rest  is  an 
aid  of  great  value.  Erlenmeyer  says  :  "  The  best 
remedy  is  rest  in  bed.  The  importance  of  quiet, 
rest  in  bed,  and  warmth  in  promoting  restoration 
during  the  abstinence  struggle,  cannot  be  over- 
estimated. I  order  every  patient  to  bed  at  the 
start,  and  can  state  with  confidence  that  those 
who  submit  to  this  till  I  allow  a  change  will  get 
along  more  easily  and  satisfactorily  during  the 
treatment  than  others  who  do  not  obe}^  but  who 
insist  on  moving  about  or  having  the  run  of  the 
premises." 

Having  thus  crossed  the  opiate  Rubicon, 
treatment  pertains,  mainly,  to  the  debility  and 
insomnia.  For  the  former,  coca  leads  the  list. 
If  fluid  extract,  2  to  4  drachms,  or  cocaine,  i  to 
2  grains,  with  other  tonics,  decreasing  as  need 


356  MODERN  TREATMENT  OF  ALCOHOLISM 

lessens.  As  a  rule,  its  use  is  ended  in  a  fortnight. 
To  remove  the  mental  and  physical  depression, 
the  minor  neuralgias,  and  the  desire  for  stimu- 
lants sometimes  noted,  nothing  equals  it,  and 
full  doses  of  tincture  of  capsicum  often  add  to  its 
value. 

Another  agent  of  much  service  is  general 
faradisation,  twenty  minute  seances  daily.  This 
imparts  a  feeling  of  exhilarating  comfort ;  but  care 
must  be  taken  not  to  overdo,  for  a  current  too 
strong  or  long  makes  mischief,  overstimulating 
and  exhausting  to  the  extent,  it  may  be,  of 
several  days'  discomfort,  which  nothing  but 
time  will  remove. 

Faradism  also  acts  kindly  in  easing  the  peculiar 
unrest — "  fidgets  " — and  the  nagging  aches  in 
legs  during  convalescence.  It  may  be  applied  in 
the  usual  way,  or  through  the  special  electrodes 
we  have  devised. 

Galvanism  is  another  general  tonic  of  value. 
Our  method  is  positive  pole  to  nape  of  neck  and 
negative  to  epigastrium  for  five  mmutes,  then 
the  former  behind  the  angle  of  each  jaw  for  a 
minute  or  two,  making  entire  seances  seven  to 
nine  minutes. 

Another  valued  tonic  is  the  cold  shower-bath. 
With  many  it  is  a  great  invigorator,  and  patients 
who  dread  it  at  first  come  to  appreciate  it  highly. 


OPIUM  INEBRIETY  357 

Internal  tonics  have  a  place  in  the  roborant 
regime.  Most  habitues  are  below  par,  and  it 
is  our  custom  to  give  such  from  the  start — 
phosphorus,  strychnine,  arsenic  and  quinine, 
combined.  After  the  opiate-quitting,  coca,  in 
some  form,  can  be  added.  If  anaemic,  ferri 
tincture,  or  Blanch ard's  pills.  Caffein  is  of 
value.  It  is  stimulant,  tonic,  and  diuretic.  We 
sometimes  give  it  with  codeine  and  cocaine. 
Digitalis  is  often  useful.  In  some  cases  cod-liver 
oil  is  of  service, — with  pepsine  and  quinine,  with 
malt,  with  phosphates,  or  plain, — and  may  be 
given  for  months. 

Some  anorexia  is  usually  present,  yet  it  may  not 
prevent  the  regular  meal,  and  need  never  occasion 
anxiety,  for  it  will  likely  give  place  to  a  vigorous 
appetite,  which  may  be  encouraged  to  fullest 
feeding  short  of  digestive  disaster.  If  it  be  slow 
in  returning,  |--grain  doses  of  cannabis,  an  hour 
before  meals,  often  have  a  marked  effect. 

Regarding  the  insomnia,  Levenstein  said  : 
"  Sleeplessness,  which  is  generally  protracted  up 
into  the  fourth  week,  is  very  distressing."  Our 
record  differs.  Wakefulness  is  an  invariable 
sequel,  but  usually  not  so  marked  nor  prolonged ; 
and  in  ordinary  cases  recovery  can  generally  be 
promised,  without  the  loss  of  a  single  entire 
night's  sleep.     We  have  known  a  patient  able 


358  MODERN  TREATMENT  OF  ALCOHOLISM 

to  dispense  with  hypnotics  in  five,  others  in 
eight,  and  the  average,  in  a  series  of  cases,  was 
eleven  nights. 

The  insomnia  is  of  two  kinds.  Most  patients 
secure  sleep  on  retiring,  but  waken  early — three 
or  four  o'clock — and  fail  to  get  more.  Others 
remain  awake  nearly  all  night  before  slumber 
comes,  and  these  usually  require  soporifics  the 
longer.  For  relief  of  this,  cannabis  indica  will 
often  suffice.  The  hemp  is  given  in  40  to  60 
minim  doses,  in  capsules,  or  mixed  with  glycerin, 
or  ginger  syrup,  two  hours  before  bedtime. 
There  may  be  noted,  in  some,  laughing  and  talking 
during  the  first  hour,  tending  to  sleep  in  the 
second.  Many  require  nothing  else.  At  the 
end  of  a  week  it  is  lessened,  and  usually  ended  in 
ten  or  twelve  days. 

Other  hypnotics,  chloral,  chloralamid,  trional, 
sulfonal,  paraldehyde,  hypnal — in  full  doses, 
often  work  well. 

Chloral,  during  the  first  five  or  six  nights  of 
opium  abstinence,  fails  as  a  soporific,  often 
causing  a  peculiar  excitement  or  intoxication, — 
patients  talking,  getting  out  of  bed  and  wandering 
round  the  room, — followed  after  several  hours  b}/ 
partial  sleep.  Later,  in  full  doses — we  prefer 
40  grs.  at  once,  rather  than  two  20-grain  doses — 
alone,  or  with  a  bromide,  it  can  be  relied  on. 


OPIUM  INEBRIETY  359 

If,  as  rarely  happens,  the  sleepless  state  is  so 
pronounced  or  prolonged  as  to  distress  patient, 
we  never  hesitate  to  give  a  full  opiate,  by  mouth, 
and  with  good  result.  Erlenmeyer  says  :  "In 
such  cases  there  remains  nothing  to  do  but  to 
resort  to  morphine.  I  give,  then,  the  alkaloid 
internally,  on  two  consecutive  evenings  ;  a  cer- 
tain cumulative  effect  takes  place.  The  first 
night,  in  the  dose  of  J  grain,  there  is  usually  no 
sleep  ,  but  on  the  second  night,  after  giving  the 
same  dose,  a  sound  sleep  of  six  hours  will  ensue. 
I  have  not  observed  any  special  danger  from  these 
resumed  doses  of  morphine,  although  I  feared 
it ,  but  after  I  was  constrained,  in  several  bad 
cases,  when  every  other  medicine  had  failed,  to 
resort  to  this,  I  was  convinced  that  my  fear  was 
groundless." 

In  all  cases  drugs  should  be  dropped  as  soon  as 
possible,  and  sleep  secured  by  a  walk  or  other 
exercise — an  electric  seance,  a  Turkish  or  half- 
hour's  warm  bath,  a  light  meal,  a  glass  or  two 
of  hot  milk,  one  or  more  of  these  before  retiring, 
Patients  whose  slumbers  end  early  often  note  a 
peculiar  depression  on  waking ;  and  if  so,  a  lunch, 
hot  milk,  cocoa,  coffee,  beef,  or  bovinine  should 
be  at  conmand. 

It  may  be  well  in  passing  to  refer  to  certain 
minor  sequelae  and  their  treatment .     If  dyspnoea 


36o  MODERN  TREATMENT  OF  ALCOHOLISM 

or  palpitation,  a  stimulant — cocoa  with  capsicum 
or  Hoffman's  anodyne  with  aromatic  spirits  of 
ammonia — will  promptly  control. 

In  aching  pains  in  the  calves,  strong  galvanic 
or  faradic  currents,  hot  water,  massages,  or 
ether  will  relieve.  If  a  peculiar  burning  in  soles, 
mustardised  foot-baths.  If  marked  hysteria, 
ether  inhalations. 

Belly  pain  may  be  eased  by  hot  fomentations, 
or  full  doses  of  ether  in  hot  water,  or  camphor 
with  capsicum.  The  latter,  with  atropine  in- 
jection, act  happily  in  ovarian  irritation. 

Very  seldom  unrest  and  insomnia  compel 
hyoscine.  If  so,  hydrobromate  y-J-g-  to  ^^  grain 
hypodermically,  or  double  by  mouth. 

The  late  Norman  Kerr  recommended  the 
following  means  of  combating  the  opium  habit  : — 

'^  "In  opium  and  morphia  inebriety,  in  whatever 

form  the  narcotic  has  been  taken,  the  procedure 
as  to  the  withdrawal  of  the  toxic  agent  ought  to 
be  different.  It  is  just  as  desirable  to  w^Hhdraw^ 
the  poison  as  speedily  as  may  be  practicable  in 
opium  and  morphia,  as  in  alcohol,  inebriety. 
But  the  difficulty  here  lies  in  the  practicability. 
Both  plans  have  been  tried  in  opiate  and  morphine 
inebriety.  The  narcotic  has  been  suddenly  with- 
held, and  it  has  also  been  gradually  tapered  off. 
Levenstein,    who    advocates   the   heroic    course, 


OPIUM  INEBRIETY  361 

has  been  iibly  answered  by  Dr.  J.  B.  Mattison, 
who  adopts  the  slower,  more  pleasant,  and  surer 
method.  Among  other  distressmg  symptoms 
after  sudden  withdrawal,  the  following  have  been 
observed  in  an  aggravated  form  : — Rigors,  nausea, 
vomiting,  exhaustive  diarrhoea,  convulsions, 
delirium,  prostration,  collapse.  Languor  and 
sneezing  are  minor  troubles.  The  agony  is  in 
many  cases  indescribable,  and  the  symptoms  are 
so  alarming,  that  the  full  narcotic  dose  of  the 
drug  has  had  to  be  given  to  avert  a  fatal  issue. 
My  sympathies  are  with  the  heroic  course,  but 
the  sufferings  undergone,  with  some  risks  (such 
as  paralysis),  consequent  on  the  peremptory 
stoppage  of  supplies,  have  forced  me  to  the  con- 
clusion that  gradual  diminution  of  the  dose 
ought  to  rule. 

"There  are  cases  in  which  immediate  cessation 
of  the  drug  occasions  comparatively  little  distress, 
and  is  successful ;  but  these  have  been,  so  far  as  I 
have  seen,  exceptional.  I  generally  spread  the 
periods  of  gradual  diminution  of  the  dose  till 
entire  discontinuance  of  the  drug,  over  four  or 
five  weeks.  The  length  of  this  tapering-off 
process,  however,  depends  chiefly  on  the  daily 
amount  of  opium  or  morphia  used,  while  taking 
the  idiosyncracy  of  the  narcotee  and  the  effect 
of  the  poison  on  the  individual  constitution  into 
account.  Occasionally  three  weeks  suffice,  but 
the  duration  sometimes  extends  over  eight  weeks. 

"Here    potassium   and    sodium   bromides   are 


362     MODERN  TREATMENT  OF  ALCOHOLISM 


•      >> 

.  20. 
40. 

fl. 

TIL  XV. 

fl. 

„    XX. 

fl. 

„    XX. 

fl. 

,,    XX. 

fl. 

oz.  iij. 

generally  indicated  in  considerable  doses  to 
subdue  the  extreme  nervous  irritability,  with 
henbane  and  cannabis  indica.  The  quantities 
administered  must  vary  with  the  individuality 
of  the  case.  Bearing  this  in  mind,  the  formula 
appended  may  be  taken  as  a  guide  : 

^  Potass,  bromid.  .     . 
Sodii  bromid. . 
Tr.  cannabis  mdic.  . 
Tr.  hyoscyami 
Sp.  ammon.  aromat. 
Tinct.  cardamom,  co. 
Aq.  destillat.  ad 
"  5.  The  draught   at   bedtime,  followed  by  a 
copious  drink  of  cold  water. 

"  When  the  patient  can  bear  the  immediate,  or 
almost  immediate,  withdrawal  of  the  drug,  a  much 
smaller  dose  of  this  bromo-hyoscy amine  mixture, 
repeated  once  or  twice,  will  be  ample.  After  a 
day  or  two,  tonic  treatment  can  be  begun. 

"The  crave  for  opium  or  morphia  is  dependent 
on  an  abnormal  physical  condition,  which  it  has 
been  claimed  that  sparteine  and  nitro-glycerine 
relieve.  I  have  not  seen  occasion  for  the  ex- 
hibition of  the  former,  and  only  once  or  twice 
for  the  prescription  of  the  latter,  the  use  of 
which  involves  too  serious  a  risk  to  justify  the 
administration  of  it  except  very  rarely,  and  with 
extreme  caution.     Professor  Benjamin  Ball  and 


OPIUM  INEBRIETY  363 

Dr.  Oscar  Jennings  have  made  a  splendid  con- 
tribution to  the  Hterature  of  morphino-mania, 
but  it  has  occurred  to  me  that  perhaps  the 
greater  need  they  have  met  with  for  the  trial  of 
such  remedies  may  have  arisen  from  sudden 
withdrawal  of  the  narcotic.  Sparteine  is  ad- 
ministered hypodermically  in  the  form  of  sulphate 
in  doses  of  from  two  to  four  centigrammes,  and 
nitro-glycerine  is  given  in  tablets  or  in  a  one  per 
cent,  alcoholic  solution. 

"  In  opium  inebriety  there  is  often  severe  and 
prolonged  sickness,  during  the  earlier  stages  of 
treatment  especially.  When  these  symptoms  are 
present,  I  find  it  advantageous  to  administer 
the  bromides  in  something  hke  this  form  for  a 
few  days,  till  the  night  draught  can  be  retained  : 

J^  Potass,  bicarbonat.  .         .         •     gr.  120. 


„   60. 

„  90. 
fl.  }\  30. 
fl.  dr.  j. 
fl.  dr.  j. 
fl.  oz.  vi. 


Potass,  bromid. 
Sodii  bromid.    . 
Tinct.  cannabis  ind. . 
Sp.  ammon.  aromat. 
Tr.  cardamom,  co.    . 
Aq.  destillat.  ad 

A  sixth  part  three  times  daily  in  effervescence 
with  an  acid  powder. 

1^:  Acid,  citric,  6  powders  of  15  grains  each. 
S.  The  acid  powders. 

Tinct.  nucis  vomicae  should  often  be  added  to 
the  above  mixture,  in  3  or  4  minim  doses. 

In  some  cases  an  ordinary  dose  of  pil.  saponis 


364  MODERN  TREATMENT  OF  ALCOHOLISM 

CO.  (Sapon.  cum  opio),  not  oftener  than  once  in 
seven  days,  acts  like  a  charm  ;  but  I  do  not  care 
to  resort  to  this  unless  in  extreme  cases.  An- 
other potent  remedy  is  ^th  of  a  grain  of 
hyoscyamine  administered  subcutaneously ;  but 
this  must  be  used  with  great  caution. 

"Coca  has  been  much  lauded  in  the  treatment 
of  opium  inebriety,  but  I  have  never  seen  any  need 
for  its  use,  and  so  can  say  nothing  in  its  favour. 

"  In  most  cases  I  begin  the  treatment  with  4 
grs.  of  blue  pill,  followed  by  a  black  draught 
or  Seidlitz  powder  next  morning. 

''Ice,  milk  and  lime-water,  or  milk  and  soda- 
water,  will  aid  in  counteracting  the  vomiting. 

"  In  all  cases  great  attention  should  be  paid  to 
the  diet,  which  should  be  nourishing,  easy  of 
digestion,  and  such  as  will  not  be  rejected  by 
the  stomach.  Peptonised  milk,  Carnick's  beef 
peptonoids,  staminal  food,  Valentine's  beef  juice, 
broths,  soups,  and  similar  preparations  are  good. 
As  soon  as  it  can  be  borne,  white  fish  cut  up  fine, 
with  a  little  of  the  juice  of  a  lemon,  is  very  grateful. 
Fresh  fruits  and  green  vegetables  are  refreshing, 
and  can  be  taken  with  benefit  before  and  after 
fowl  and  flesh  can  be  retained  and  assimilated. 
Fatty  foods,  when  these  agree,  are  of  great  value 
in  the  remedying  of  nerve  starvation. 

''  In  certain  cases  the  Turkish  bath  aids  in  pro- 
curing sleep  as  well  as  in  soothing  the  nervous 
irritability.  At  other  times  these  objects  will  be 
secured   more    easily   and   cheaply,    occasionally 


OPIUM  INEBRIETY  365 

more  effectually,  by  the  wet  pack,  which,  however, 
must  be  carefully  applied,  or  it  will  do  more 
harm  than  good.  Dip  a  sheet  in  hot  or  tepid 
water,  the  former  being  preferable.  Wring  the 
wet  sheet  well,  and  closely  envelop  the  whole 
body  (except  the  head  and  neck)  in  it.  Above 
this,  leaving  no  part  ol  the  damp  sheet  un- 
covered, roll  a  blanket  round  the  body.  Then 
add  successive  wrappings  of  a  couple  or  more 
blankets.  The  patient  will  generally  be  in  a 
profuse  perspiration  within  three-quarters  of  an 
hour.  He  should  not  be  allowed  to  remain  in  the 
pack  longer  than  75  minutes,  even  when  sleep 
has  not  been  won.  The  application  may  in 
suitable  cases  be  repeated  daily,  every  second  or 
third  day,  according  to  the  circumstances.  To 
avoid  any  possible  risk,  the  pack  should  be  applied 
not  less  than  two  hours  or  more  than  three  hours 
after  food.  I  have  seen  an  excellent  calmative 
influence  exerted  on  the  opiist  by  this  simple 
and  agreeable  procedure.  Wherever  this  pleasant 
sedative  soporific  can  be  employed,  in  all  forms  of 
inebriety  I  prefer  it  to  the  exhibition  of  large 
doses  of  narcotic  drugs  to  secure  sleep.  That  it 
is  a  pleasant  process  I  have  had  many  a  happy 
experience,  having  a  vivid  recollection  of  how 
annoyed  I  used  to  be  with  the  bath  attendant, 
when  undergoing  this  treatment  during  an  attack 
of  blood-poisoning,  for  always  rousing  me  out  of  a 
delicious  snooze  when  he  came  to  unwrap  me. 
The  well-wrung  hot-water  sheet  is  an  admirable 


366     MODERN  TREATMENT  OF  ALCOHOLISM 

soother  of  nerve  perturbation,  and  it  is  im- 
possible for  me  to  speak  in  too  high  terms  of  its 
efficacy  in  lessening  the  extreme  restlessness 
occasioned  by  the  reflex  nervous  irritation,  which, 
with  sleeplessness,  signalises  the  first  week  of  the 
treatment.  This  remedial  measure  is  also  potent 
to  procure  sleep,  and  has  not  the  drawback  of 
disturbing  the  system,  which  belongs  to  chloral 
and  other  narcotics. 

"  I  pursue  a  somewhat  similar  course  of  treat- 
ment in  morphia  injection,  the  dose  being  steadily 
diminished  day  by  day,  a  weekly  full  narcotic 
dose  of  opium  with  belladonna,  or  chloral  with 
bromides,  at  night  instead  of  that  day's  reduced 
hypodermic  dose. 

"  I  never  allow  opium  or  morphia  inebriates  any 
alcoholic  intoxicant.  The  Eastern  proverb,  '  One 
death  is  bad  enough,  two  or  three  deaths  are  the 
very  devil,'  is  peculiarly  applicable  here.  There 
is  a  danger  of  alcohol  or  chloral  inebriety  being 
added  to  the  opium  habit.  The  cases  of  this 
double  and  treble  narcomania  which  I  have  seen 
have  been  too  sad,  nearly  all  having  ended  in 
suicide,  for  me  to  run  the  risk  of  promoting  such 
a  combination  and  development." 

The  New  Chinese  Treatment  of  the 
Opium  Habit 

The  treatment  does  not  come  from  China  but 
from  the  Straits  Settlements,  and  the  name  was 


OPIUM  INEBRIETY  367 

given  to  it  because  it  was  discovered  by  the 
Chinese  in  that  country.  The  story  of  the 
discovery  is  as  follows  : — Some  Chinese  woodmen 
while  at  work  ran  out  of  tea,  and,  being  of  a 
resourceful  nature,  collected  some  leaves  of  a 
climbing  plant  called  Combretum  sundaicum, 
which  they  roasted  and  made  tea  of.  Apparently 
the  tea  was  sufficiently  satisfactory  to  induce 
them  to  continue  its  use.  The  Chinese  have  the 
reputation  of  being  the  most  economical  people 
known  ;  they  waste  nothing.  Instead  of  empty- 
ing the  ashes  of  their  opium  pipes  away  they  put 
them  into  the  teapot.  The  carrying  out  of  this 
habit  by  the  Chinese  woodmen  had  a  remarkable 
effect,  namely,  they  found  that  they  lost  all 
desire  to  smoke  their  opium.  On  returning  to  the 
Settlement  they  told  others  of  their  discovery  ; 
tests  were  made,  with  satisfactory  results.  The 
matter  was  brought  to  my  notice,  and  I  obtained 
a  supply  of  the  roasted  leaves  direct  from  the 
Settlement.  These  came  mixed  with  a  consider- 
able proportion  of  small  twigs  cut  into  lengths  of 
2  inches  or  3  inches.  A  decoction  of  this  is  made 
as  follows  :  2j  oz.  of  the  mixed  leaves  and  stems 
are  weighed.  The  stems  are  then  bruised  in  an 
iron  mortar,  and  over  the  whole  is  poured  80  oz. 
of  boiling  water  ;  the  vessel  being  then  covered, 
it  is  placed  where  it  will  simmer  for  four  hours. 


368     MODERN  TREATMENT  OF  ALCOHOLISM 

after  which  the  cover  is  removed,  and  when  the 
contents  are  reduced  to  40  oz.  it  is  strained  through 
butter-cloth.  The  method  of  its  use  is  as 
follows  :  If  the  patient  is  an  opium  smoker,  a 
quantity  of  opium  equal  to  what  he  uses  daily  is 
burnt  and  the  ashes  mixed  with  20  oz.  of  the 
preparation.  This  is  put  into  one  bottle  and 
labelled  "A."  Of  this  he  is  given  ^  oz.  several 
times  a  day,  at  such  times  as  he  may  feel  the  need 
of  the  drug.  Six  or  seven  doses  a  day  is  generally 
the  amount  used.  The  bottle  is  kept  filled  by 
adding  from  bottle  "  B  "  (which  contains  the 
remainder  of  the  decoction  which  has  had  no 
opium  added  to  it).  When  the  contents  of  bottle 
"  B  "  is  used  up,  the  patient  then  finishes  entirely 
from  bottle  "A,"  without  anything  further  being 
added  to  it.  I  have  tried  the  remedy  upon  the 
cases  commonly  met  with  in  this  country,  i.e., 
morphia  users,  laudanum,  paregoric,  and  chloro- 
dyne  takers,  the  particular  drug  used  by  each 
patient  being  added  to  bottle  "  A  "  in  the  same 
way  as  the  opium  ashes  mentioned  above.  If 
one  bottle  of  the  preparation  should  not  be 
enough  to  complete  the  cure,  then  a  second  bottle 
is  prepared,  adding  a  much  reduced  quantity  of 
the  drug  to  bottle  "A."  Three  bottles  are 
generally  sufficient  to  effect  the  cure.  The 
results  of  the  treatment  are  remarkable  in  some 


OPIUM  INEBRIETY  369 

cases.  Patients  who  have  struggled  for  years 
to  master  the  habit  without  success  are  able  to 
do  so  by  the  aid  of  this  drug.  Another  striking 
feature  is  the  absence  of  the  need  for  restraint  in 
many  cases.  Patients  were  given  the  remedy 
to  use  at  home,  with  instructions  to  report 
every  five  or  six  days.  A  further  feature 
of  the  treatment  is  the  unanimity  with  which 
the  patients  express  the  absence  of  un- 
pleasant symptoms  during  the  withdrawal  of 
the  drug. 

Being  the  first  to  use  the  drug  in  this  country 
so  far  as  I  know,  I  desire  to  restrain  all  enthusi- 
asm, and  to  record  only  such  results  as  I  can 
personally  vouch  for.  It  is  always  unwise  to 
say  too  much  about  a  new  remedy,  and  I  feel 
that  a  greatly-increased  experience  of  the  drug 
than  I  have  been  privileged  to  enjoy  is  necessary 
before  one  is  justified  ii'  recommending  it  strongly 
to  the  profession.  My  present  opinion  may  be 
summed  up  as  follows  : — 

First,  If  the  patient  is  earnestly  desirous  of 
being  cured,  has  the  average  amount  of  will- 
power, the  habit  of  moderate  dosage,  and  fairly 
recent,  he  will  find  the  drug  all  that  is  necessary 
to  enable  him  to  overcome  the  craving  without 
restraint  or  discomfort. 

Second,  In  more  advanced  cases  with  feebler 
24 


370  MODERN  TREATMENT  OF  ALCOHOLISM 

will-power  it  is  a  valuable  aid  to  other  treatment, 
and  restraint  is  not  necessary. 

Third,  In  all  inveterate  cases  where  restraint 
and  constant  supervision  are  necessary,  I  consider 
it  well  worth  a  trial  in  conjunction  with  other 
remedies.  Personally,  I  use  it  in  all  drug  cases 
which  come  to  me  for  treatment.  With  this  drug 
and  the  auto-condensation  couch  of  high  fre- 
quency many  difficulties  in  the  treatment  of  the 
drug  habit  are  solved.  If  the  case  is  a  very 
chronic  and  obstinate  one,  the  use  of  mechanical 
massage,  in  addition  to  the  above,  will  still  further 
lessen  the  difficulties  of  treatment,  and  render 
great  comfort  to  the  patient.  Where  this  is 
available  it  should  always  be  given  a  trial — the 
results  are  often  most  agreeable  to  the  patient 
and  surprising  to  the  doctor. 

The  following  cases  will  illustrate  the  usefulness 
of  the  drug  : — 

Case  I. — Woman,  aged  40,  had  become  ad- 
dicted to  the  use  of  morphine  in  the  form  of 
chlorodyne,  the  latter  being  suggested  by  her 
nurse  for  the  relief  of  abdominal  pains.  She  had 
been  unable  to  do  without  the  drug  for  several 
years,  her  general  health  had  given  way,  and  she 
was  in  a  deplorable  condition.  I  put  her  upon 
a  liquid  form  of  Combretum  sundaicum,  and 
in  five   days  she  did  without   any   chlorodyne. 


OPIUM  INEBRIETY  371 

and     was    quite    well    at    the    end     of    three 
weeks. 

She  was  under  no  restraint  whatever,  and  only 
saw  me  on  four  occasions  during  the  time  she 
was  under  my  care.  She  had  no  companion  or 
attendant  to  help  her  regulate  the  treatment. 
After  leaving  off  the  chlorodyne  the  patient  had 
a  return  of  the  abdominal  pains,  but  these 
rapidly  subsided  when  a  few  doses  of  phenacetine 
had  been  administered.  During  the  last  two 
weeks  of  treatment  the  general  health  rapidly 
improved  on  the  addition  of  some  simple  vegetable 
tonics  to  the  remedy. 

Case  II. — A  medical  man  who  had  lost  his 
practice  through  the  use  of  laudanum,  and  who 
was  trying  to  earn  a  living  as  a  traveller,  came 
under  treatment  in  April  1907. 

He  was  thirty  years  of  age,  and  could  do  very 
little  work  owing  to  his  broken  health.  I  placed 
him  under  a  decoction  of  Combretum  sundaicum, 
and  told  him  to  reduce  the  drug  as  rapidly  as  he 
felt  he  was  able  to.  It  took  him  three  weeks  to 
leave  off  the  opium,  but  he  admitted  that  it  was 
done  without  the  slightest  inconvenience ;  and  I 
am  convinced  that  if  he  had  had  any  one  to  advise 
and  help  him,  he  could  have  left  it  off  quite  as 
easily  at  the  end  of  ten  or  twelve  days.  He 
reported  himself  to  me  whenever  he  required  a 
fresh  supply  of  medicine,  and  worked  during  the 
whole  time  of  his  treatment.     His  general  health 


372     MODERN  TREATMENT  OF  ALCOHOLISM 

greatly  improved  during  the  course,  and  when 
he  left  off  taking  the  remedy  I  prescribed  a 
simple  tonic  for  a  week. 

Case  IIL — A  man,  aged  60,  applied  to  me 
for  treatment  of  the  morphia  habit.  He  reported 
himself  as  in  too  feeble  a  state  of  health  to  under- 
take the  journey  from  Liverpool  to  London.  I 
sent  him  the  medicine  in  the  form  of  a  decoction 
at  various  intervals  of  four  or  five  days  for  some 
six  wrecks.  This  was  in  May  1907.  He  had  no 
attendant,  and  I  had  to  depend  upon  his  wish  to 
get  well.  He  gave  up  the  use  of  morphia  in 
fourteen  days'  time,  although  he  had  been  a  slave 
to  it  for  many  years.  He  then  reported  that  he 
was  still  troubled  by  an  old  weakness  of  the 
bladder,  which  had  prevented  him  from  sleeping 
properly  at  night,  but  he  thought  the  medicine 
was  helping  this  also.  I  advised  him  to  continue 
the  remedy  for  a  while  longer,  and  report.  The 
result  was  most  satisfactory,  all  the  vesicle 
symptoms  clearing  up  and  leaving  the  patient 
in  a  remarkable  state  of  health,  considering  his 
age  and  complications.  The  only  other  drug 
used  was  a  few  doses  of  phenacetine  for  some 
rheumatic  pains. 

Case  IV. — A  young  man,  aged  24,  who  had 
used  laudanum  regularly  for  five  years,  was 
treated  by  a  decoction  of  Combretum  sundaicum, 
and  gave  up   taking  the  opium  in  two  weeks. 


OPIUM  INEBRIETY  373 

He  then  suffered  from  an  attack  of  acute  dyspepsia 
brought  on  by  overfeeding,  as  he  was  under  the 
impression  that  he  required  to  take  plenty  of  food 
to  offset  the  withdrawal  of  the  opium.  He 
suffered  great  pain  during  the  attack,  and  re- 
verted to  the  laudanum  in  medicinal  doses  for 
two  days.  After  I  had  relieved  the  gastric 
distress  he  left  off  the  opium  entirely,  and  rapidly 
regained  his  health.  He  worked  throughout  his 
treatment,  with  the  exception  of  the  three  days 
of  illness  referred  to.  He  came  under  treatment 
in  April  1907. 

Case  V. — A  medical  man  from  the  Midlands 
came  under  treatment  in  May  1907.  He  was 
forty  years  old,  and  had  been  a  victim  of  morphia 
for  ten  years  He  came  to  London,  took  lodgings, 
and  recovered  so  rapidly  that  in  fourteen  days 
he  returned  to  work,  although  I  strongly  advised 
him  to  the  contrary.  He  did  not  finish  his 
treatment,  and  his  case  was  not  satisfactory. 
He  has  since  asked  to  be  treated  under  proper 
medical  supervision,  and  admits  that  the  remedy 
was  of  great  help  to  him. 


INDEX 


Abbott,  32. 

Advice  to  patients,  228. 

Albumen,  action  of  alcohol  on, 

10. 
Alcohol,  a  poison  to  protoplasm, 

12. 
and  heat  loss,  41. 
Alcoholic  trance,  283. 
Ancient  Egyptians,  2. 
Anthrax,    effect   of    alcohol   in, 

26. 
Aristotle,  49. 

Bare,  Dr.,  50. 

Bayerinck's  phosphorescent 

bacilli,  14. 
Bergey,  39. 
Berkley,  23. 
Bernard,  21. 
Blood  vessels,  action  of  alcohol 

on,  24. 
Bordet,  33. 

Bradford,  Sir  John,  45. 
Brain,  action  of  alcohol  on,   23. 
Brain  cells,  action  of  alcohol  on, 

24. 
Bromides,  158. 
Brunton,  Sir  Lauder,  41. 

Cabanis,  Dr.,  4. 

Calmette,  32. 

Canada,  drinking  habits  in,  63, 

Cardio-vascular   changes  due  to 

alcohol,  17, 
Carthaginian  laws,  49. 


Cases,  268. 
Chinese  herb,  366. 
Chloral  habit,  145. 
Chlorodyne  habit,  143. 
Chloroform  habit,  146. 

inebriety,  316. 
Christian  era,  2. 
Classification  of  inebriety,  104. 
Climate,  58. 
Cocaine  habit,  147. 
Coffee  inebriety,  324. 
Cold  and  alcohol,  60. 
Combretum  sundaicum,  366. 
Condillac,  3. 

Confidence  of  patients,  228. 
Constant  drinker,  the,  104. 
Cramner,  Dr.  Buhl,  4. 
Crothers,  Dr.,  50. 


:    Dacaiene,  Dr.,  51. 

I   Dangers  of  some  cough  mixtures, 

138- 
Day,  Dr.,  50. 

Definition  of  alcoholism,  149. 

Dehio,  23. 

Delearde's,  Dr.,  experiments, 
26. 

Delirium  tremens,  249. 

Diagnosis  of  alcoholism,  193. 

Diet  treatment,  180. 

Diodorus,  2. 

Diogenes,  49. 

Dipsomaniac,  the,  122. 

Diseases  as  a  cause  of  alcohol- 
ism, 65. 


INDEX 


375 


Dodge,  Dr.,  50. 
Drink  madness,  2. 
Drug  inebriety,  128. 

Ehrlich,  37. 

Environment    as     a     cause     of 

alcoholism,  85. 
Esquirol,  Dr.,  4. 
Ether  inebriety,  299. 

First  week's  treatment,  233. 
Fothergill,  Dr.  Milner,  44. 
Fruit  cure,  184. 
treatment,  213. 

Gastro-intestinal  tract,  21. 
General  debility  as  a  cause,  79. 
Generous  diet  cure,  189, 
Gould,  Dr.  Pearce,  32. 
Grape  cure,  187. 
Greek  philosophers,  2. 

Haemolysis  and  alcohol,  38. 
Heart,  action  of  alcohol  on,  16. 

disease  as  a  cause,  66. 
Heat  loss  and  alcohol,  41. 
Heredity  as  a  cause,  47. 
Herodotus,  2. 
Heroin  habit,  136. 
History  of  a  social  club,  86. 
Home  treatment,  207. 

Indian  hemp,  152. 
Indigestion  as  a  cause,  68. 

Kerr,  Dr.  Norman,  48. 

Laitinen's  experiments,  31. 
Laudanum  using,  140. 
Liver,  action  of  alcohol  on,  19. 
Lycurgus,  49. 

Mason,  Dr.,  50. 

Massart,  33. 

Meat  diet,  184. 

Mental  condition    as    a    cause, 

81. 
Metchnikoff,  33. 


Mognan,  50. 

Moral  treatment,  163,  209. 

Morphine  habit,  131. 

Mucous  membrane  and  alcohol, 

22. 
Myers,  37. 
Mythology      and       alcoholism, 

49- 

Nerve  fibres  and  alcohol,  24. 
i    Nervous    system    and    alcohol, 
23. 
Neurasthenia  as  a  cause,  74. 
Nuttall,  37. 

Ocean    trips    and    alcoholism, 

Opium  inebriety,  128. 
treatment  of,  334. 
treatment,  Chinese,  366. 

Paregoric  habit,  142. 

Parrish,  Dr.,  50. 

Pasteur,  36. 

Periodical  drinker,  the,  104. 

Phagacytosis  and  alcohol,  25. 

Plants,    action    of    alcohol    on, 

13- 
Plutarch,  2. 

Preparatory  treatment,  225. 
Protoplasm,  action  of  alcohol  on, 

10. 

Rabies  and  alcohol,  26. 
Raisin  cure,  187. 
Rauber's  experiments,  13. 
Religious  observances  as  a  cause, 

100. 
Restraint  treatment,  167. 
Results  of  treatment,  261. 
Ridge,  Dr.  J.  J.,  12. 
Roberts,  Sir  WilHam,  21. 
Roman  writers,  3. 
Rush,  Dr.,  4. 

St.  John  Chrysostom,  2. 

Salvator,  4. 

Second  week's  treatment,  240. 


376 


INDEX 


Sleeping  powders,  153. 
Social    customs     as     a     cause, 
94. 

Spanish  laws,  3. 

Stomach,  action  of  alcohol  on, 

22. 
Suggestion,  253. 
Sulphonal  habit,  155. 
Syphilis  as  a  cause,  80. 

Tea  inebriety,  324. 
Temperature  and  alcohol,  36. 
Tetanus,    effect    of   alcohol    in, 

26. 
Third  week's  treatment,  240. 
Thirst  habit,  160. 
Tonic  mixture,  238. 
Traumatism  as  a  cause,  52. 
Treatment,  162. 
in  Colonies,  214. 


Treatment — 

by  drugs,  190. 

by  restraint,  216. 

by  travelling,  210. 

of  morphia  habit,  276. 

of  opium  habit,  334. 

of  periodicals,  254. 
Trianol  habit,  154. 

Uhlenhuth,  37. 
Ulpian,  2. 

Vegetable  diet,  183. 
Veronal  habit,  155. 
Voluntary  drinkers,  the,  126. 

Water-melons,  188. 
WTiite,  W.  Hale,  21. 
Woodhead,  Dr.  Sims,  11. 
Worry  and  trouble  as  causes,  91. 


Printed  by   Morrison  &  Gibb  Limited,  Edinburgh 


<^.< 


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